Occupational Summary   

• Accurately complete patient accounts based on departmental protocol, policies and procedures, and compliance with regulatory agencies, to include but not limited to pre-admission, admission, pre-registration and registration functions.
• Ensure all insurance requirements are met prior to patients' arrival and inform patients of their financial liability prior to arrival for services.
• Arrange payment options with the patients and screens patients for government funding sources.

Work Performed

• Analyze insurance coverage and benefits for service to ensure timely reimbursement.
• Obtain all Prior Authorization Certification and/or authorizations as appropriate.
• Facilitate payment sources for uninsured patients.
• Determine if patient's condition is the result of an accident and perform complete research to determine the appropriate source of liability/payment.
• Admit, register and pre-register patients with accurate patient demographic and financial data.
• Resolve insurance claim rejections/denials and remedy expediently.
• Calculate and collect cash payments appropriately for all patients.
• Reconcile daily cash deposit.
• Evaluate diagnoses to ensure compliance with the Local Medicare Review Policy.
• Perform those duties necessary to ensure all accounts are processed accurately and efficiently.
• Compile departmental statistics for budgetary and reporting purposes.
• Explain bills according to PRMO credit and collection policies.
• Implement appropriate collection actions and assist financially responsible persons in arranging payment.
• Make referral for financial counseling.
• Determine necessity of third party sponsorship and process patients in accordance with policy and procedure.
• Examine insurance policies and other third party sponsorship materials for sources of payment.
• Inform attending physician of patient financial hardship.
• Complete the managed care waiver form for patients considered out of network and receiving services at a reduced benefit level.
• Update the billing system to reflect the insurance status of the patient. Refer patients to the Manufacturer Drug program as needed for medications.
• Greet and provides assistance to visitors and patients.
• Explain policies and procedures, and resolves problems.
• Gathers necessary documentation to support proper handling of inquiries and complaints.
• Assist with departmental coverage as requested.
• Obtain authorizations based on insurance plan contracts and guidelines.
• Document billing system according to policy and procedure.
• Enter and update referrals as required.
• Communicate with insurance carriers regarding clinical information requested and to resolve issues relating to coverage and payment.

Knowledge Skills and Abilities

• Excellent communication skills, oral and written.
• Ability to analyze data, perform multiple tasks and work independently.
• Must be able to develop and maintain professional, service-oriented working relationships with patients, physicians, co-workers and supervisors.
• Must be able to understand and comply with policies and procedures.

Level Characteristics

• Position responsible for high production generated accurately in accordance with established business processes or regulation.
• Requires working knowledge of compliance principles.Job
• allows the opportunity to work independently.