PATIENT ACCESS SERVICES REP II, GENERAL SURGERY

Description

Location: Professional Building

Department: SPN - GENERAL SURGERY

Schedule: Full Time, 8 HR Day Shift, 8-5 M-Th; 8-12 Fri

Position Summary

Responsible for the complete registration of a patient. Will be held accountable for meeting the standard productivity rate of 94% to 105%. Must understand and comply with HIPPA. Knowledgeable of Medicare and the questionnaire that must be completed on each Medicare patient. Responsible for verifying insurance benefits and accurate entry of patient demographics and financial data. Will be responsible for fulfilling all PayNav functionalities including medical necessity on all Medicare patients, cost estimates for each patient and insurance verification on all patients. Strive to reach 100% of your personalized collection goal. Will be accountable for accuracy of information entered and documentation provided. Will be held accountable for meeting the standard accuracy rate of 98% or higher in AHIQA. Will coordinate referral of account to appropriate personnel, including Customer Service Representatives, Billers, and Patient Account Collectors.

Knowledge, Skills & Abilities

• PC and Windows literacy required
• Prefer knowledge of, or experience with, Series, Trace, PayNav, and Microsoft Office applications.
• Extensive knowledge of insurance/managed care, to include: Medicare; Medicaid (Georgia and Florida); Peach Care; Tricare (Standard, Extra and Prime);VA; Disability Adjudication Services; Vocational Rehabilitation; Children’s Medical Services; Cancer State Aid; Crime Victim’s Compensation Program; Knight’s Templar Eye Foundation; Managed Care (HMO, PPO, POS, Medicare HMO); COBRA; Worker’s Compensation; Georgia Indigent Care Trust Fund; Blue Cross (Georgia, Florida, out-of-state and FEP); and Institutional Billing.
• Strong verbal communication skills.
• Excellent customer service skills. Interacts with: patients; other departments; physician offices; other acute medical care providers; insurance companies; pre-certification companies; employers; intermediaries; utilization review companies; and state regulatory agencies (GMCF, Medicaid).
• Knowledge of, or coursework in, medical terminology.
• Familiarity with CPT Codes, HCPCS, and ICD-10, and PCI compliance.
• Related regulatory and legal requirements: Medicare Secondary Payer Questionnaire; Advance Directives (living wills, healthcare surrogate); medical necessity checking requirements; ABNs; letters of non-coverage; coordination of benefits.
• Reimbursement methodologies: percent-of charges; discounted fee-for-service; fee schedule; cost-based; capitation.
• Must have a thorough understanding and knowledge of patient type; financial class; insurance master; employer codes; clinic codes; physician coding; admission source codes; relationship codes; accommodation codes; special handling codes; medical service codes.
• College degree or coursework preferred.
• CPAR preferred.
• Must be able to organize workload in an efficient manner and type 40 wpm accurately.
• Previous data entry, programming, office coordinator experience highly preferred.
  
  

Working Conditions- Ada Information

Modern, well-lighted, air-conditioned, general work area. Moderate noise level. Occasional overtime required. May be at risk for exposure to blood and body fluids. Ability to sit, stand or walk for moderate periods. Safe and efficient operation of office equipment including copier, fax, printers, computer, telephone, adding machine, Medifax, and credit card machine. Reading of printed materials, including physician orders. Listening and verbally responding to customers, staff, physicians and visitors. Moderately heavy lifting {0-25 lbs.}, reaching, stooping, pushing, pulling, bending, and twisting.