Pre-Access Pre-Certification Lead (Full-time) at Billings Clinic in Billings, Montana

Job Description:

Pre-Access Specialist Lead is responsible for one of the first impressions a patient will have of Billings Clinic. Incumbent will provide education both verbally and via mail in an effort to manage the patient and/or family member's expectations as a patient of our facility. New and some established patients for both clinic and hospital services will be contacted to obtain all patient and guarantor information, insurance information including any information related to accident insurance, etc. as well as additional contact information. All regulatory requirements as to determination of primary and secondary carrier status will be collected. Staff will inform patient/family member of insurance billing processes as well as payment expectations. Payment policies will be reviewed as well as any need for co-payment and/or coinsurance/deposit requirements. An explanation of what the patient can expect at check-in will be provided as well as information regarding parking, valet services, etc. Patients will be provided with a customized new patient welcome packet including their scheduling itinerary and way finding materials. Through the conversations during registration and demographic information collection, staff will provide patients with information regarding the need to contact Financial Representatives in reference to financial assistance and/or payment arrangements. Addresses will be verified electronically by staff members.


Essential Job Functions


• Supports and models behaviors consistent with Billings Clinic's mission, vision, values, code of business conduct and service expectations. Meets all mandatory organizational and departmental requirements. Maintains competency in all organizational, departmental and outside agency standards as it relates to the environment, employee, patient safety or job performance
• Provides first impression of Billings Clinic to patients and family members. Focus on patient service is first and foremost.
• Validates insurance entries using Intellisource software, commercial web site, or calling insurance company and analyzes electronic/verbal responses ensuring appropriate set-ups dependent upon State where services are being rendered.
• Coordinates with patients, internal and external providers, nursing staff to ensure Medicaid Passport and other authorizations for referrals required by insurance carriers are obtained and entered onto specifically approved encounters within the revenue cycle system.
• Schedules and coordinates appointments in a manner that meets the patient's needs and is in keeping with each individual provider's scheduling protocols for the various appointment types, lengths of appointments and any pre-appointment requirements as outlined by the providers.
• Review and analyzes AccuReg edits completes corrections in accordance with AccuReg worklist daily.
• Consistently uses searching techniques within the Registration system to identify existing Billings Clinic health information record for additional updating.
• Accurately obtains all patient, guarantors, primary, secondary and tertiary insurance information from patients and verifies patient/guarantor primary residence address as well as insurance eligibility and co-pay requirements on-line. If unavailable on-line, contact insurance carrier via phone to verify all information. Familiarizes self in various insurance cards and identification to assist patient in providing accurate information.
• Participates in quarterly assessments in accordance with policies and procedures.
• Reviews, analyzes and interprets information obtained to determine regulatory requirements that may exist including completion of MSPs, gathering of third-party payors in relation to accidents, etc. Maintains this knowledge for both a clinic and hospital setting.
• Uses processes and information to manage a patient's expectations for parking, check-in process, way finding, insurance billing turnaround times, etc. Prints patient's custom schedule itinerary, way finding tools and department specific information along with new patient welcome packet (if needed) and mails to patient.
• Discusses Billings Clinic expectations for payment of services by supplying patient with verbal explanation of our payment policies to include co-pays, coinsurances, and/or deposits to be made at the time of service in conjunction with Billings Clinic policies and procedures.
• Provides assistance in ensuring patients are directed to the appropriate resources within the organization if questions arise as to the patient's ability to pay. Provides patients with financial assistance applications if appropriate.
• Ensures all work lists are completed within guidelines and provides appropriate hand-off information to others to ensure all patients are contacted.
• Performs other duties as assigned or needed to meet the needs of the department/organization.


Minimum Qualifications


Education


• High School graduate or GED equivalent
• Advanced Medical Terminology required (or able to obtain within 6 months)


Experience


• Prior experience in customer service-related field required; healthcare experience is desirable
• Previous healthcare reimbursement and/ or insurance experience preferred