PATIENT REFERRAL SPECIALIST in Gillette, Wyoming at Campbell County Health

JOB SUMMARY

The Pre-Admissions Coordinator performs pre-certification and verification on all eligible patients. This position requires a broad understanding of third-party reimbursement issues. Performs detailed and accurate registration of patients, including telephone interviews on eligible patients. Provides estimates to patients of scheduled procedures. Works under the supervision of the Patient Access Manager.

Processes insurance pre-verification for hospital admissions or specialty service office visits. Gathers pertinent information from patients, insurance carriers, financial counselors, and other staff to confirm the patient's financial obligations for services. Acts as a liaison between hospitals, clinical staff, health plans, providers, and patients to process referrals. Verifies insurance coverage and obtains required authorizations when necessary. Documents referrals, communications, actions, and other data in an information management system. Generates and distributes all applicable forms, notifications, and paperwork. Requires a high school diploma.

ESSENTIAL FUNCTIONS

• Collects new Inpatient/ Observation/ Outpatient surgical/ High Tech Radiology accounts daily to coordinate pre-certification and verification with insurance companies.
• Inputs detailed and accurate registration of patients, including telephone interviews on eligible patients.
• Monitors Inpatient accounts to ensure that all releases and signatures have been obtained.
• Performs pre-certification of admission and verification of insurance coverage on inpatient admissions and eligible outpatient procedures so that insurance companies are notified, and denials are eliminated.
• Calculates estimates of patient balances on eligible scheduled procedures.
• Coordinates with physician’s offices/surgery department/Radiology departments to obtain patient information needed for pre-admission interview, to submit accurate billing, days prior to arrival at the hospital.
• Communicates closely with Utilization Review and Case Managers on IP admissions completing tasks requested.
• Performs general admitting duties while covering in Admitting Department during clerk absences and participates in the rotation of on-call for the Emergency Room on weekends and holidays.
• Maintains a thorough knowledge of hospital admitting policies as well as third-party private insurance reimbursement procedures and coverage so that pre-certifications can be performed accurately/timely.
• Completes retro-authorization requests and other assigned tasks for Patient Accounting Reps.
• Reconciles Advance Directive Information to ensure Accuracy in Advance Directive Documentation.
• Obtains payment/ co-payment and deposits from patients as appropriate or refers patient to Patient Accounting to make standard payment arrangements.
• Maintains confidentiality of all personnel and patient care and relations information.
• Actively participates in Strategic Quality Management for the department and organization.
• Actively participates in Customer/Guest Relations and Mandatory Education programs.
• Complies with the hospital’s Corporate Compliance Program including, but not limited to, the Code of Conduct, laws and regulations, and hospital policies and procedures.
• Must be free from governmental sanctions involving health care and/or financial practices.
• Other duties as assigned. This list is non-exhaustive.

JOB QUALIFICATIONS

1. Education, Training, Experience:

• Education: High School graduate or GED equivalent.
• Education: High School graduate or GED equivalent.
• Licensure: None.
• Certifications required: See Cardiopulmonary Resuscitation Certification Policy and Certifications/Education Requirements Policy.
• Experience: Prior medical office and/or hospital admitting experience including billing preferred. Prior customer relations experience required. Prior computer keyboarding and 10-key calculator experience required. Medical terminology knowledge preferred.