Patient Access Representative III - CommonSpirit Health

Baylor St. Luke’s Medical Center is an internationally recognized leader in research and clinical excellence that has given rise to breakthroughs in cardiovascular care neuroscience oncology transplantation and more. Our team’s efforts have led to the creation of many research programs and initiatives to develop advanced treatments found nowhere else in the world. In our commitment to advancing standards in an ever-evolving healthcare environment our new McNair Campus is designed around the human experience—modeled on evidence-based practices for the safety of patients visitors staff and physicians. The 27.5-acre campus represents the future of healthcare through a transformative alliance focused on leading-edge patient care research and education. Our strong alliance with Texas Heart® Institute and Baylor College of Medicine allows us to bring our patients a powerful network of care unlike any other. Our collaboration is focused on increasing access to care through a growing network of leading specialists and revolutionizing healthcare to save lives and improve the health of the communities we serve.

Assist in providing access to services provided at the hospital. Knowledge of all tasks performed in the various verification/pre‐certification area is necessary to provide optimum internal and external customer satisfaction and provide the opportunity for accurate reimbursement. The position basic function is for the verification of eligibility/benefits information for the patient’s visit, obtaining Pre‐cer/Authorization/Notifying Third Party payers within compliance of contractual agreements with a high degree of accuracy. Participates in upfront collections by informing the patient of the estimated patient portion during insurance verification. Responsible for establishing the hospital’s financial expectation for the patient and/or guarantor and ensuring accurate information is exchanged which determines whether the account will be processed in an efficient and expedient manner for the hospital and the patient.

ESSENTIAL KEY JOB RESPONSIBILITIES
1. Obtains detailed patient insurance benefit information.
2. Discusses benefits and other financial issues with patients and/or family members during initial evaluation.
3. Advises patients on insurance and billing issues and options. Serves as a resource for patients and their family members on financial matters.
4. Coordinates all necessary payer authorizations.
5. Consistently monitors and updates information regarding insurance data, physicians, authorizations and managed care contracting.
6. Assists patients and their families with questions concerning insurance and other financial issues.
7. Identifies and effectively communicates financial information team members, patients and their families with emphasis on identifying any potential patient out‐of‐pocket liability.

8. Works with patients, their families and team members when possible to help address insurance coverage gaps via alternative funding options.
9. Facilitates resolution of patient billing issues.
10. Ensures payers are listed Accurately, pertaining to primary, secondary, and/or tertiary coverage and billing when a patient has multiple third party/governmental payers listed on an account.
11. Process patient accounts and deploy established policies to resolve insurance issues with patient accounts.
12. Initiate pre‐cert for in‐house patients when required, obtaining pre‐certification reference number, approved length of stay, and utilization review company contact person and telephone number. 
13. Notify hospital Case Managers on all in‐house patients regarding insurance plan changes/COB order, out of network plans, and Medicare supplemental plans that require pre‐certification.
14. Contact physician’s on scheduled patients, to notify them of authorization requirements and any possible financial holds.
15. Analyze reports to ensure admission dates for patient type changes are accurate in order for the account to appear on insurance verification reports.
16. Maintain and update reference notebooks on insurance companies, employers, pre‐certification requirements, etc to stay current on changes within the insurance industry.
17.May function as team lead to ensure smooth operation of daily activities. This may include assisting with coverage, scheduling, providing feedback, and quality assurance.

Required Education and Experience:

• High School Diploma/GED
• Two (2) years of related experience

Required Minimum Knowledge, Skills, Abilities and Training:

• Extended knowledge of HMO’s , PPO’s, Commercial/Governmental payers and System/Entity specific hospital contracts with Third Party payers.
• Extended knowledge of HIPPA and EMTALA.

Disclosure Summary:

The job summary and responsibilities listed above are designed to indicate the general nature of the work performed within this job. They are not designed to contain or be interpreted as a comprehensive inventory of all job responsibilities required of employees assigned to this job. Employees may be required to perform other duties as assigned.