Work Shift:
Day (United States of America)
Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advance technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made up of more than 250 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.
Position Overview:
- Demonstrates service excellence by professionally assisting patients and customers with the utmost respect in a friendly caring manner.
- Follows all payor requirements, and identifies needs for referrals and precertification. Performs verification of benefits on all patient encounters. Audits chart for accurancy.
- Follows computer system, internet based insurance applications, and department operational procedures and training guidelines to obtain accurate demographic, diagnosis, authorizations/referrals and insurance information on each registration.
- Works collaboratively with other departments, physicians, physician office staff to obtain essential registration information such as insurance authorization, referrals, diagnosis’s, and scripts, to secure financial reimbursement and customer/patient satisfaction.
- Complies with department procedures and regulatory guidelines for Medicare Secondary Payer, Medicare Necessity Regulations, Collection of co-pay/deposit, Advance Beneficiary Notice, Advance Directives, and Patients Rights.
- Registers established goal of minimum required patients per employee shift as measured by productivity reports. Correctly identifies a patient according to policy, completes all patient registration types by collecting and entering accurate patient demographics, physician information, insurance information and valid category codes. Ascertains and records appropriately the difference between patients primary care, referring physician and attending physician. Obtains all necessary signatures. Assures insurance information is verified and authorization is obtained if not done prior to service, essential registration forms are scanned into Alpha, and chart follow up is performed as needed.
- Ascertains and records appropriately the difference between primary care physician, referring physician and attending physician.
- Expert in participating CH insurance plans and the ability to identify non participating plans.
- Follows payer requirements for authorization, pre-authorization, referrals, coordination of benefits forms, and in-network verification according to department procedures and the Insurance Card Database and Insurance Verification guidelines. Performs verification of benefits either electronically or by telephone according to department procedures and guidelines. Identifies and obtains required precertification, authorizations and/or referrals and audits all information in the appropriate registration and billing system.
- Follows Financial Screening and Self Pay Procedure with regards to referrals for Medicaid and Charity Care. Makes appropriate referrals to Medicaid, Medicare and Charity for patients determined to be under insured or uninsured. Completes PE Medicaid and FD80 forms for maternity patients
- Attends all mandatory department meetings.
- Supports department performance improvement initiatives.
MINIMUM REQUIREMENTS
- Education: High school diploma or GED.
- Experience: Six months in a Health Access Rep role at Capital Health required. Additionally, one year experience in a healthcare setting or one year customer service experience with medical terminology and basic computer skills required.
- Knowledge and Skills: Excellent communication, interpersonal and organizational skills. Ability to problem solve and multitask and manage frequent interruption. Expert and current knowledge of all aspects of insurance requirements.
- Special Training: Proficient computer skills. Familiar with medical terminology. A quality of knowledge of insurance plans and insurance experience preferred.
- Mental, Behavioral and Emotional Abilities: Ability to handle a stressful environment.
- Usual Work Day: 8 Hours
PHYSICAL DEMANDS AND WORK ENVIRONMENT
- Frequent physical demands include: Sitting , Standing , Walking , Wrist position deviation , Pinching/fine motor activities , Keyboard use/repetitive motion
- Occasional physical demands include: Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl
- Continuous physical demands include: Talk or Hear
- Lifting Floor to Waist 15 lbs. Lifting Waist Level and Above 10 lbs.
- Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Accurate Depth Perception, Accurate Hearing
- Anticipated Occupational Exposure Risks Include the following: Bloodborne Pathogens , Airborne Communicable Disease , Extreme Noise Levels , Dust/Particulate Matter
Offers are contingent upon successful completion of our onboarding process and pre-employment physical. Capital Health will require all applicants to have an annual flu vaccine prior to start date, with the exception of individuals with medical and religious exemptions.
"Company will never ask candidates for social security numbers or date of birth during application phase. If you are asked for this information online, you may be a target for identity theft."
