Position Summary: The representative independently has these major responsibilities: completes upfront Financial Clearance; determines Presumptive Charity; provides Customer Service for both internal and external customers; uses good communication and customer service skills; uses professional and ethical judgment and critical thinking when performing their duties; and uses equipment, materials, and systems according to policies, procedures, and practice standards.

Responsibilities:

Initial Customer Contact: calls or writes scheduled patients to introduce and provides patient education in regard to billing, payment, and facilitates the patient’s access to the medical center’s services. Pre-certification and Eligibility Process: contacts payers to review benefit and eligibility requirements and completes any necessary pre-certification; documents pre-certification details; verifies payers coverage of new procedures; develops medical service charge estimates; and informs patient of pre-certification and eligibility and estimate findings. Charity: screens patients for charities or discounts; refers eligible patients to outside contractor for public assistance; assists patient in completion of application; reviews application; makes recommendations; routes recommendation to the Chief Financial Officer for approval; upon approval makes necessary adjustment in electronic patient account system; contacts patient to set up monthly repayment on balance. Collection Follow-up: runs and reviews daily reports of aging accounts receivables and collection work lists; contacts patients on outstanding accounts; documents conversation and correspondence regarding accounts Clerical Support: receives and processes mail by responding to patient and/or payer requests; documents interaction with patient and/or payer; and receives telephone inquiries from patients, payers or internal customer service representatives. Customer Service: serves as a liaison between patients, payers and other healthcare members (internal and external).

Qualifications: 

Required:

High school graduate or equivalence 

Preferred:

Satisfactory performance and one-year experience. Knowledge of health insurance, processing personal information, answering phones or other office training is preferred.

Infection Control: Initial and Ongoing training in dealing with infection control. Trainings could include, but are not limited to, blood-borne pathogens, bodily fluids and biohazardous materials as it applies to your daily work environment.

Patient Interaction: Periodic 

HIPAA: This position will have access to the following Protected Health Information in order to carry out the duties related to their position at Hays Medical Center based on the following criteria:
Primary – required (routine) to do the job;
Secondary – required for the job, but mostly be exception; and
None – no approved access

Description of Information
Primary:
Patient Demographic Information (information used to identify a person): Name, Date of Birth, Address, Race, Marital Status, Religion

Clinical Information (information that describes a patient’s health status): Diagnosis, Reports/Medical Notes, Test Results, Problem List, Procedures, History and Physical

Coding Information (clinical information that is in (alpha) numeric format): ICD-9 Codes, Rev Codes, CPT Codes

Financial Information/Insurance (information related to insurance, billing and payment): Billing Information, Payer Name, Payer ID, Account Balances, Plan Elements Covered, Payment Information, Payment Rate