High school or GED
American Heart Association CPR
This position is accountable to perform departmental patient accounts functions. This position must demonstrate a commitment of quality service to patients, the public, and Associates. The incumbent in this position will be responsible for compliance with all federal and state laws and regulations governing the privacy of patients' protected health information.
As an EOE/AA employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.
Essential Functions & Responsibilities:
Interfaces courteously and effectively with all departmental customers providing assistance as appropriate.
Responsible for obtaining timely insurance authorization and verification for patients who require services from Mary Washington Home Health. Verifies patient eligibility, insurance coverage information and ensures authorization requirements have been met. Obtains initial and subsequent authorization for all non-Medicare payers before services are rendered including over visit limits. For self-pay and/or charity patients, verifies eligibility for all Medicaid products.
Assists Intake Specialists, Clinicians and billing department with communicating patient/guarantor financially responsibility when clarification is needed, or variance occurs.
Audits patient admissions. Monitors appropriate reports related to insurance verification and authorization processes to ensure timely notification and insurance verification processing.
Responsible for follow-up and monitoring compliance with CMS guidelines regarding face-to-face documentation. Monitors and initiates sending face-to-face documents to the certifying physician for signature. Monitors return and appropriateness of returned documentation.
Monitors payor communications/updates (e.g., "CMS").
Demonstrates a thorough knowledge of insurance guidelines including Medicare and Medicaid regulations related to HHPPS/CGS.
Provides feedback to all appropriate Managers on appropriate payer issues and trends.
Audits explanation of benefits. Generates timely and accurate routine end of month statistical reports and special ad hoc reports in support of ongoing operations and performance improvements. Identifies and recommends process improvements within the registration processes.
Other duties as assigned.
High School Diploma required.
At least one year of collection, patient registration required, preferably in a healthcare setting.
Excellent customer service and telephone skill.
Knowledge of methods, practices, and terminology used in medical, financial, and statistical work.
Demonstrated written & verbal communications skills.
Demonstrated proficiency in current personal computer applications, i.e. Microsoft Office applications.
Two years of collection or patient registration experience. Collection experience in a health care setting preferred.
Computer skills necessary for data management, one to two years progressively responsible data processing experience preferred.
Accounting or record keeping experience in a medical setting desirable.