POSITION GOAL

Knowledge of insurance contracts and payor benefits and eligibility requirements. Calculate co-payments, deductibles based on insurance contracts in order to determine patient liabilities for all elective cases (inpatient and outpatient). Assess all direct admits. Assist in insurance verification and calculation of patient liabilities. Work with case management for any outstanding issues with insurance coverage and assist with precertification issues as needed. Prepares the daily deposit for the department and reconciles all money with our patient logs. Communicates ongoing systematic issues to leadership.

POSITION RESPONSIBILITIES

• Review scheduled procedures and tests in order to determine patient’s financial liability, price charts, and to screen for medical necessity (ABN), if indicated.
• Assist scheduling, verification/precertification staff in order to ensure that all scheduled accounts insurances have been verified, precertification requirements have been satisfied and all patient liabilities have been calculated prior to patients arrival.
• Assist with coverage when needed in registration, ER, front desk, and PBX.  Maintain open communication with management in order to communicate any status of scheduled patients as well as direct admits.
• Reviews the daily schedule for IP, OP, and ER for self-pay patients for targeted interactions, collections, and Charity Care eligibility.
• Reviews the daily schedule and validates the correct HSV status. Responsible for financially clearing, calculating payment estimates, and counseling Self-Pay patients for elective procedures.
• Work closely with case management to assist with any insurance or precertification issues.
• Set up payment arrangements/monthly installment plans for patients to pay off their balances within JHMH financial guidelines.
• Assists patient in understanding of their insurance benefits.
• Educate and communicates to patient access staff, the collection process for any and all patient responsibility portions.
• Reviews charts for accuracy and completes charts from prior shifts.
• Collaboratively work with bedside registrar to collect point-of-service monies due.

POSITION REQUIREMENTS

Experience:

Required:

• 1-2 years of previous office experience in a hospital or medical office, patient access or financial services
• 1-3 years Financial Counselor experience preferred. Excellent computer and math skills
• Must have exceptional customer service skills as well as verbal and non-verbal communication skills.
• Must be knowledgeable of health insurance, benefit eligibility, HIPAA and Current Procedure Terminology (CPT), ICD-10, and medical terminology.

Education:

Required:

• High School Diploma or equivalent required.

Preferred:

• Associate Degree or higher

Special Qualifications:

Required:

• Ability to work independently.
• Ability to interact well with the public, i.e. children, adolescents, adults and geriatric.
• Ability to work in a fast-paced, high-stress environment.
• Exceptional customer service skills.
• Ability to use Microsoft Office and other software packages.

Preferred:

• Certified Patient Accounts Representative (CPAR)
• Certified Healthcare Access Associate (CHAA-NAHAM) preferred.

The Hughston Clinic, The Hughston Foundation, The Hughston Surgical Center, Hughston Clinic Orthopaedics, Hughston Medical, Hughston Orthopaedics Trauma, Hughston Orthopaedics Southeast and Jack Hughston Memorial Hospital participate in E-Verify. This company is an equal opportunity employer that recruits and hires qualified candidates without regard to race, religion, color, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.