Imaging Services Representative - Catholic Health

Catholic Health is one of Long Island’s finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island.

At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes – to every patient, every time.

We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace!

The Scheduling Representative is responsible for managing incoming and outgoing calls for Catholic Health Radiology service line.

They will support the Catholic Health system by scheduling and collecting all necessary demographic and financial information to ensure streamlined access to care and throughput for radiology services.

The Representative will ensure the patient has active insurance coverage, collect demographic information, acquire and explain benefit information, confirm patient responsibility amounts, and secure authorization for services.

Scheduling Representative will communicate policies, protocols and instructions relevant to the service being scheduled, providing a positive patient experience.

DUTIES/RESPONSIBILITIES:

Registration

• Utilize workqueues/workdrivers and reports as assigned by management, to complete daily tasks
• Interview patients to verify and/or obtain demographic, insurance, employer and general encounter information.
• Confirm with the patient/responsible party the need for pre-certification and/or authorization for tests. 

• Documentation into Epic

• Notify patient or patient representative of the expected out-of-pocket expenses (deductible, copayment, non-covered service).  Request payment for the patients out of pocket responsibility while patient is on the phone.
• Educate the patient of the pertinent policies, protocols and instructions as necessary.
• Confirm that initial and subsequent authorizations.
• Utilize analytical, problem solving skills to determine the best course of action to resolve any problems. 
• Keep Supervisor informed of any potential services that may be at financial risk.
• Propose innovative ideas and solutions to enhance operational efficiencies.
• Maintain knowledge of scheduling guidelines, facility structure and navigating situational responses.
• Validate appropriate demographic, clinical and financial information has been collected to ensure excellent patient experience.
• Complying with Medical Necessity protocols and proper use of Compliance Checker and National Coverage Decisions.
• Maintain knowledge of payer regulations and collection policies.
• Stay abreast of changes in Medicare, Medicaid and third-party payer reimbursement requirements.
• Responsible for other duties as assigned.

Scheduling & Pre-Registration

• Contacts patients in order to coordinate the scheduling of appointments for various services and completes scheduling process in EPIC.
• Collects necessary data in order to create a complete and accurate preregistration for scheduled appointments.
• Verifies insurance activity via insurance eligibility systems in order to confirm active status.
• Communicates with Financial Counselors, physician offices, patients, Financial Clearance Center, and PAS staff in order to ensure accuracy of orders and securing of appropriate authorizations. 
• Follows department specific scheduling guidelines and insurance parameters when scheduling appointments.
• Appropriately communicates to patients any relevant appointment instructions.

Insurance Verification

• Confirm that a patient’s health insurance(s) is active and covers the patient’s procedure; may be completed multiple times before, during, and after a patient’s visit/stay. 

• Document a patient’s health insurance benefits and coverage for their visit including effective date of the policy, product line, coverage limitations / requirements, and patient liabilities for the type of service(s) provided.
• Check benefits to determine deductible, coinsurance, and copayment amounts due.

• Use procedure estimate process/program to notify the patient of the amount due.  
• Make patients aware of financial obligations and appropriately refer them to financial counseling when necessary.
• Collect co-payments, co-insurance, deductible and self-pay fees prior to or at the point of service. Documents collections in the system and on a daily collection log, and provides patient with receipt.
• Verify a patient’s network status (in or out-of-network) with their plan and communicate to the patient in advance if an out-of-network status applies.

• Ensure payer requirements including the following are met:

• • Verify and document insurance eligibility; confirm and document benefits
  • Review of clinical documentation to ensure the treatment/services are appropriate for the diagnosis as determined

• Review and analyze patient visit information to determine whether authorization is needed and understand payer specific criteria to appropriately secure authorization and clear the account prior to service where possible.

SECURITY ACCESS:  CONFIDENTIAL INFORMATION

Incumbents may have access to confidential patient, employee and/or organizational information as it applies to their job responsibilities and must comply with the terms of CHS policies in protecting that information.

CHS Core Expectations:

At CH, we expect all our employees to live the values of Reverence, Integrity, Compassion and Excellence by:

• Honoring and caring for the dignity of all persons in mind, body, and spirit
• Ensuring the highest quality of care for those we serve
• Working together as a team to achieve our goals
• Improving continuously by listening, and asking for and responding to feedback
• Seeking new and better ways to meet the needs of those we serve
• Using our resources wisely
• Understanding how each of our roles contributes to the success of CHS.

POSITION REQUIREMENTS AND QUALIFICATIONS:

Education:

High School Diploma or equivalent experience required

Skills, Knowledge or Abilities critical to this role:

• Comprehensive understanding of insurance, pre-certification requirements, and medical terminology. 

• Work requires the ability to access online insurance eligibility and pre-certification systems.

• Must be customer focused with strong interpersonal skills, courtesy and tact with patient, family members, physicians and staff members.

• Work requires a high level of problem solving skills
• Work requires the ability to interpret and execute policies and procedures.
• Work requires the ability to ensure the confidentiality and rights of patients and the confidentiality of hospital and departmental documents.

• Must be able to demonstrate a working knowledge of personal computers and other standard office equipment

• Must demonstrate a positive demeanor, good verbal and written communication skills, and be professional in appearance and approach. 

• Must be able to handle potentially stressful situations and multiple tasks simultaneously. 

• Must be able to successfully complete additional job related training when offered.

Physical Requirements:

Reasonable accommodation will be made to enable individuals with disabilities to perform the essential physical demands.

Experience:

Minimum of 1 years of experience in Revenue Cycle Management or Patient Access Services functions. 

This range serves as a good faith estimate and actual pay will encompass a number of factors, including a candidate’s qualifications, skills, competencies and experience. The salary range or rate listed does not include any bonuses/incentive, or other forms of compensation that may be applicable to this job and it does not include the value of benefits.

At Catholic Health, we believe in a people-first approach. In addition to the estimated base pay provided, Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth.