Sr Patient Finance Rep

Position Summary / Department Summary
Ensures all required demographic, insurance, referral and authorization data is collected, verified, entered and communicated appropriately. Coordinates activities with physician offices, service sites, ancillary departments, case managers and insurance representatives to proactively complete financial pre-processing of patients. Handles financial pre-processing for the full range of hospital services, including outpatient appointments, inpatient, day surgery and observation encounters. Proactively engages patients and family members to determine coverage limitations and financial liability. Identifies trends, denials, issues impacting account resolution or workload, and refers as appropriate. Maintains a basic understanding of 3rd party payer contracts as well as a working knowledge of payer referral and authorization requirements.

• Manages daily assignments using standardized protocols and work queues to ensure timely completion of financial clearance in accordance with departmental processes and payer guidelines.

• Collects, verifies, and records all demographic information required for patient financial clearance in accordance with hospital policy.

• Verifies insurance eligibility utilizing available technologies, payer websites, or by phone contact with third party payers. Works in accordance with required State and Federal regulations and hospital policies.

• Ensures that correct insurance company name, address, plan, and filing order are recorded in the patient accounting system.

• Uses payer exception reports to update coverage / PCP information.

• Contacts PCP (primary care physician) offices to secure referrals and enter referrals into patient accounting system.

• Collaborates with clinical departments, case managers and clinical liaison to ensure payer authorizations are obtained timely.

• Proactively engages patients and family members to determine coverage limitations and financial liability.

• Communicates with physician offices, service sites and ancillary departments if referrals/authorizations are denied at least 72 hours prior to service date.

• Facilitates peer-to-peer reviews when needed to secure authorizations.

• Documents all actions taken on accounts with clear and concise account notes.

• Participates in process improvement activities.

• Required Education: High School / GED

• Preferred Education: None Specified

• Required Work Experience: 1 year of direct experience working with health insurance, referrals and authorizations.

• Preferred Work Experience: None Specified

• Ability to communicate effectively in English both orally and in writing and provide empathy in difficult interpersonal situations.

• Ability to resolve complex problems requiring the use of basic scientific, mathematical, or technical principles is required.

• Well-developed customer service skills and a good understanding of computer systems are required. Familiarity with basic medical terminology is required.

• Ability to work as part of a team with diverse internal and external constituencies.

• Effective organizational skills and the ability to work in a fast-paced environment to ensure completion of work within established timeframes.

• Attention to detail and completion of tasks with accuracy.