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Job Description
VALLEY MEDICAL CENTER
Patient Access Services
The position description is a guide to the critical duties and essential functions of the job, not an all-inclusive list of responsibilities, qualifications, physical demands and work environment conditions. Position descriptions are reviewed and revised to meet the changing needs of the organization.
TITLE: Patient Account Rep – Insurance Verification
JOB OVERVIEW: This position is responsible for ensuring the timely financial clearance of insured accounts.
This position will be responsible for but not be limited the following functions: timely and accurate creation of accounts, insurance verification pre-authorization, notification, pre-determination, and financial clearance of accounts prior to service. All functions must be accomplished while operating within the guidelines of Federal and State agencies as well as within the confines of contractual agreements with insurance companies.
ROLE: See job description for Administrative Partner for generic job duties. Exempt Professional Position.
AREA OF ASSIGNMENT: Financial Access
RESPONSIBLE TO: Financial Access Manager
PREREQUISITES:
- High School Graduate or equivalent (G.E.D)
- Two or more years of equivalent work experience in a hospital, medical office/clinic, or insurance company
- Demonstrated knowledge of Microsoft Excel, Word, and Outlook, as well as healthcare financial systems. EPIC and ePremis system experience would be preferred.
- Evidence of excellent communication skills both oral and written form in the English language including the ability to spell accurately and write legibly.
- Demonstrated knowledge of insurance eligibility and financial clearance
- Demonstrated knowledge of medical terminology and abbreviations
- Excellent customer service skills
Page 2 – (Patient Account Rep – Insurance Verification)
QUALIFICATIONS:
- Demonstrates excellent team skills
- Ability to communicate in writing and verbally in the English language in an effective manner.
- Ability to set priorities, produce accurate work and process all work tasks in a timely and comprehensive manner.
- Excellent organizational skills, including the ability to function in a setting with a wide variety of duties and numerous interruptions.
- Comprehensive knowledge of insurance benefits, non-covered services, exclusions, pre-existing, limited benefit plans, and other less common plans
- Proven experience with online verification websites for eligibility, notifications, benefits, and medical criteria
- Ability to interact professionally and effectively with a wide variety of people, including operations staff, providers, patients and departments in Valley Medical Center.
- Neat, well-groomed, professional appearance.
- Requires manual and finger dexterity and vision corrected to normal range.
UNIQUE PHYSICAL/MENTAL DEMANDS, ENVIRONMENT AND WORKING CONDITIONS: Also see generic job description for administrative partner.
- Must be able to stand or sit for extended periods.
- Must be able to withstand the repetitive motion of keyboarding for extended periods of time.
- Must be able to respond to patients’, physicians’, and other customers’ questions, concerns, and comments in a professional manner.
PERFORMANCE RESPONSIBILITIES:
A. Generic Job Functions: See Generic for Administrative Partner
- Unique Job Functions:
- Adheres to Valley Medical Center’s Patient Identification guidelines
- Reviews and edits information in healthcare ADT system, ensuring all fields associated with insurance and billing requirements are populated correctly and appropriately.
- Maintains current knowledge of Insurance Plan updates to ensure that bills produced are compliant with Medicare, Medicaid and other payer billing requirements.
Page 3 – (Patient Account Rep – Insurance Verification)
- Ensures accounts are registered, verified and financially cleared per procedures and guidelines
- Adheres to all financial clearance deadlines
- Collaborates with teammates and department coordinator to ensure work is completed timely according to policy and department guidelines
- Reviews own work to prioritize tasks based on financial clearance and department needs
- Ensures timely notification of hospital admissions according to payor requirements via fax, online, or telephone call.
- Scans copies of appropriate documentation; including, but not limited to, referral, authorization or notification information.
- Refers accounts that have not met financial clearance guidelines to financial advocates in accordance to department standards and guidelines.
- Regularly attends online webinars as available and reviews payor bulletins and updates to stay on top of changing requirements
- Collaborates with Revenue Cycle departments, PFS, HIM, UM, and IT as needed and required for financial clearance
- Communicates system and access needs to coordinator and manager in a timely manner so as not to interrupt or delay the financial clearance process
- Maintains flexibility in job duties to allow for cross training based on department needs
- Maintains thorough documentation of work done on every account
- Actively participates in all workflow design or process improvement work groups, as assigned by manager, coordinator or lead
- Maintains confidentiality of all accessible patient financial and medical records information and views information only on a needs to know basis
- Completes annual learning requirements assigned by department and organization
Page 4 – (Patient Account Rep – Insurance Verification)
- Adheres to hospital and department guidelines concerning dress and display of name badge, presenting an appearance appropriate to the work environment.
- Demonstrates awareness of the importance of cost containment for the department by providing suggestions regarding process or quality improvement opportunities to department management.
- Adheres to Service Culture Guidelines to enhance the patient experience; focusing on Patients are First and patient satisfaction.
- Adheres to all department and VMC policies and standards
- Other duties and responsibilities as assigned.
Date Developed:
Date Revised: 06/2017
Job Qualifications:
PREREQUISITES:
- High School Graduate or equivalent (G.E.D)
- Two or more years of equivalent work experience in a hospital, medical office/clinic, or insurance company
- Demonstrated knowledge of Microsoft Excel, Word, and Outlook, as well as healthcare financial systems. EPIC and ePremis system experience would be preferred.
- Evidence of excellent communication skills both oral and written form in the English language including the ability to spell accurately and write legibly.
- Demonstrated knowledge of insurance eligibility and financial clearance
- Demonstrated knowledge of medical terminology and abbreviations
- Excellent customer service skills
QUALIFICATIONS:
- Demonstrates excellent team skills
- Ability to communicate in writing and verbally in the English language in an effective manner.
- Ability to set priorities, produce accurate work and process all work tasks in a timely and comprehensive manner.
- Excellent organizational skills, including the ability to function in a setting with a wide variety of duties and numerous interruptions.
- Comprehensive knowledge of insurance benefits, non-covered services, exclusions, pre-existing, limited benefit plans, and other less common plans
- Proven experience with online verification websites for eligibility, notifications, benefits, and medical criteria
- Ability to interact professionally and effectively with a wide variety of people, including operations staff, providers, patients and departments in Valley Medical Center.
- Neat, well-groomed, professional appearance.
- Requires manual and finger dexterity and vision corrected to normal range.