Patient Access Representative III - Insurance Verification

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

Job Summary

Position is responsible for mentoring other employees as a team leader, scheduling patient appointments, ensuring medical necessity compliance, verifying eligibility, and posting payments.

Job Description

Minimum Qualifications

Education: High School Diploma or GED preferred

Licenses/Certifications: (None)

Experience / Knowledge / Skills:

• Three (3) years of experience in a hospital or medical business office setting

• Ability to multi-task

• Proficient typing/keyboarding skills

• Supervisory and/or leadership experience preferred

Principal Accountabilities

• Schedules patient appointments and enters required information in the computer system in an accurate and timely manner.

• Obtains demographic, insurance and financial information from patient or guarantor. Enters information in computer system with a high degree of accuracy.

• Explains all required forms to the patient or guarantor and obtains the necessary signatures.

• Ensures medical necessity compliance by obtaining necessary data, reviewing Compliance System, communicating information to patient or guarantor and obtaining necessary signatures.

• Protects the financial integrity of the facility by collecting patient liability, establishing payment arrangements, discussing payment options and screening for eligibility. Completes complex financial counseling including the review and submission of charity applications. Identifies alternative resources for financial reimbursement.

• Verifies insurance eligibility and benefits and ensures all notifications and authorizations are completed within the required timeframes.

• Posts payments in the computer system and generates the appropriate patient receipts.

• Monitors, reviews and resolves patient account issues on assigned reports. Performs account analysis and trending.

• Completes quality review and monitors for process improvement opportunities.

• Functions as a team leader in the department by ensuring daily processes are complete, scheduling employees, providing answers to employee questions and assisting in employee orientation and training.

• Communicates in an effective and professional manner with Physicians, Care Management, ancillary departments, nursing units, physicians' office staff, insurance companies, as well as patients and their families (all Patient Access customers). Completes thorough and accurate documentation.

• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.

• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann's service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.

• Other duties as assigned.