Receives and greets patients courteously and pleasantly upon arrival.
Interviews patients by telephone or in person to collect demographic, guarantor, insurance, and financial data required for billing.
Mails or telephones appointment reminders to patients.
Verifies insurance coverage and admission dates; explains facility policies, payment responsibilities, and credit policies.
Financially counsels patients and families, collecting or arranging payment at the time of preadmission or registration. Documents all account activity to ensure proper billing.
Identifies patients unable to meet complexity/payer mix requirements; assists in identifying community resources for follow-up care matching their clinical needs and personal priorities.
Handles all pre- and post-billing inquiry functions; responds to written correspondence and directly with patients regarding inquiries, resolves patient charge disputes, and processes patient refunds.
Identifies adjustments/discounts on claims, initiates resolution of accounts placed with collection agencies, and collects or arranges financial arrangements for patient balances.
Initiates the pre-admission insurance verification process by obtaining basic insurance information from the patient; contacts insurance carriers to obtain reference numbers and notifies patients of insurance acceptance.
Obtains authorization from managed care companies to cover outpatient services. Secures pre-certifications as required by the plan. Works with the managed care office to identify and interpret contracts governing patient care.
Collects referrals from patients, enters information into the electronic health record system, and forwards originals to billing for appropriate recording.
Prepares various correspondence and reports, clinic consultation notes, referral letters, and other departmental correspondence. Maintains appropriate files of all correspondence.
Initiates problem solving to resolve patient questions/complaints and refers escalated concerns to appropriate sources for resolution.
Performs other duties as assigned.
Qualifications
High school diploma or equivalent with five years of related work experience required. Bachelor's degree preferred.
At least two years of experience in hospital patient accounting processes and hospital information systems, or related work experience.
Knowledge of scheduling templates, insurance verification, third-party collection procedures, and responding to insurance and related companies on behalf of the patient.
Knowledge of hospital billing and collection processes.
Excellent writing, verbal communication, organizational, and customer service skills.
Ability to work effectively on multiple tasks simultaneously, work independently, use discretion and good judgment, and handle confidential information appropriately.
Ability to type 35 words per minute.
Proficient in Microsoft Office products and applicable systems.