The Patient Financial Representative is responsible for the accurate and timely verification of insurance and benefit information for patients receiving inpatient medical, inpatient psychiatric, observation, ambulatory surgery and/or outpatient procedure related services. Plays a key role in the organization's financial health by obtaining or ensuring that insurance authorizations or pre-authorizations are on file and accurate prior to the service being rendered. This position must also ensure patient demographic and insurance information is correct, resulting in accurate claims for reimbursement. Position provides excellent customer service during all interactions.

Core Job Responsibilities

For designated services, this position is responsible for ensuring that each patient account has accurate insurance information entered in the correct billing order and that each insurance listed has been verified as eligible for the designated date of service range. For each insurance, benefit information is obtained and documented. Verification and benefit information can be obtained via electronic or verbal method but must be completed prior to services being rendered. Position must have or develop excellent working rapport with surgeons’ office staff, as well as hospital nursing staff.
For pre-scheduled services, this position is responsible for verifying that authorization is on file with each of the appropriate insurance companies and that authorization is accurate based upon location, CPT code, service type, surgeon, date range and any or all other necessary elements to secure payment for services rendered. For emergent or urgent services, this position is responsible for accurately and timely requesting that each verified insurance company has been notified of patient services being rendered and also request authorization for requested services. Position must have or develop excellent working rapport with insurance company representatives, surgeons’ office staff, as well as hospital nursing staff.
Ensures each patient account has accurate insurance information entered in the correct billing order and that each insurance company listed has been verified as eligible for the designated date of service range.
Secures and documents any and all authorization requirements in appropriate computer systems with relevant information to capture authorization timely. Enters pertinent information in all necessary systems. Retains any written documents received.
Performs related duties as assigned.

Education/Experience Requirements

REQUIRED:

High school diploma or equivalent.
Minimum 3 years of pre-authorization and/or insurance verification experience.
Demonstrated computer proficiency and ability to learn new applications rapidly.
Strong documentation skills.
Strong follow up skills, accuracy and attention to detail.
Excellent customer service and interpersonal skills.
Ability to work under restrictive time.

PREFERRED:

Associate’s degree in healthcare related field.
4 years or more of hospital, medical office, coding or billing experience; or 6 years of experience in other healthcare related field.
Proficient with EMR, QES, MIDAS, SIS and related computer programs.

Licensure/Certification Requirements

PREFERRED:

Medical terminology certification.

Disclaimer

Qualified applicants will receive consideration for employment without regard to their age, race, religion, national origin, ethnicity, age, gender (including pregnancy, childbirth, et al), sexual orientation, gender identity or expression, protected veteran status, or disability.

Successful candidates might be required to undergo a background verification with an external vendor.

Job Details

Req Id 93721
Department PATIENT ACCESS SERVICES
Shift Days
Shift Hours Worked 8.00
FTE 0.94
Work Schedule HRLY NON-UNION
Employee Status A1 - Full-Time
Union Non-Union
Pay Range $19 - $25/Hourly

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