PAT ACCT CLERK 2 - PRE REGISTR
CANTON-OH-44701-United States
Purpose of Position:
- The purpose of this position is to reduce denials through proactive practices.
Skills and Qualifications:
- High school graduate, minimum
- Comprehensive knowledge of Patient Access process, Clinical Care process and Revenue Cycle
- Knowledge of medical terminology and managed care concepts preferred
- Experience in CPT and ICD coding preferred
- Refined communication skills, both written and oral
- Ability to cope with the stress of the position and deadlines imposed
- Refined organization skills with a well-developed style of diplomacy
- Ability to function independently, displaying personal integrity and always maintaining confidentiality
- Professional manner and appearance in accordance to the Aultman Hospital policies
- Comprehensive knowledge of computer and the software systems utilized by the clinical, registration and patient financial services departments
Primary Responsibility:
- Verify the payer source of all inpatient and OBV patients
- Determine eligibility and benefits
- Coordinate all authorizations and pre-certifications by directly contacting payer
- Mange all outpatient prior authorization requirements for all scheduled tests or procedures
- Provide insurance related information to Case Management and Utilization Management staff
- Communicate any changes identified in the verification process to the Utilization Management staff to assure proper reimbursement
- Responsible for Patient Access related denied claims in the Denials Mgmt software system
Job Specific Requirements:
- Initiate the verification and pre-certification of insurance benefits as soon as possible post admission or pre admission when possible by electronic eligibility systems, payer website or telephone
- Convey required information to third party payers to meet requirements ensuring payment for services
- Work cooperatively with physicians offices to obtain necessary information
- Contact payers and/or phys offices to secure prior authorization for scheduled procedures
- Accurately record information in MPAC system as a method of communication with PFS to facilitate correct billing of services
- Communicate any issues of patient financial concerns to the Patient Outreach department
- Function as a team member, working closely with the Utilization Management specialist, Case Managers and Social Workers to promote positive patient outcomes
- Identify areas for inter and intradepartmental operational improvements
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