Description
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DMC Rehabilitation Institute of Michigan is one of the nation’s largest hospitals specializing in rehabilitation medicine and research. RIM is known for its clinical expertise in spinal cord injury, brain injury, stroke, amputee, orthopedics and catastrophic injury care. The Institute houses the Center for Spinal Cord Injury Recovery and the Southeastern Michigan Traumatic Brain Injury System (SEMTBIS), one of only 16 federally designated model systems of care for brain injury care and research. RIM also operates 31 outpatient sites throughout southeast Michigan specializing in sports medicine and orthopedics.
Job Summary Under limited supervision functions as a resource to Patient Access Representative I. Provides training and orientation on department methods, procedures and policies. Provides input for establishing departmental policies and procedures.
- In conjunction with Lead, resolves complex eligibility or insurance verification problems through contacts with patient or patient family, state or government agencies, other hospital departments and third party payers.
- Assists Financial Counselor with financial counseling services to help patients in identifying and obtaining payment sources. Resolves complex and/or sensitive issues and recommends appropriate actions.
- Participates in bed management as defined in operating unit policies and procedures. Verifies insurance coverage and benefits, obtains and analyzes necessary authorizations and referrals, and calculates estimated patient liability.
- Reviews, monitors, and reconciles patient accounts to ensure accurate bill production.
- Ensures compliance with third party payer requirements. Registers and schedules patients for health services ensuring appropriateness of setting for services provided Explains appropriate forms to patient and family and ensures that necessary consent, regulatory forms, and MSP questionnaire (if applicable) are completed correctly and that patient signatures are obtained.
- Obtains accurate insurance, medical and demographic data to admit or pre-admit patients to the health facility. Verifies insurance coverage and benefit levels with various third party payers and analyzes authorization and referrals, calculates estimated patient liability.
- Determines patient co-pay/deductibles and collects payment as outlined in hospital policies.
- Assists patients without medical insurance coverage in completing medical assistance applications and/or making payment arrangement and cash collections. Coordinates scheduling of all tests and/or services utilizing current clinical guidelines.
- Develops liaison relationship between patient and health facility by answering patients questions regarding health facility policies and billing procedures and by obtaining necessary information to efficiently register and accurately bill for services rendered.
- Assists patients in completing necessary forms and obtains patient signature as needed.
- Collects referrals and authorizations; attempts to secure telephone referral if necessary. Completes telephone registrations as appropriate.
- Resolves bill holds in a timely manner to ensure completion within 5-day bill hold reconciles and corrects any rejected transactions on user specific Transmission, Control and Errors (TCE) reports. Assist and participates in special projects as assigned.
- Communicates clinical, financial, and administrative information. Performs duties of Lead as requested. Performs other duties as assigned.
Qualifications
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1. High school diploma, associate degree in related area desired.
2. Two to three years of progressively more responsible experience in patient access, hospital registration or related area.
3. Advanced knowledge of third party payers requirements, reimbursements and copayments/deductible collections etc.