Patient Finc Rep

GENERAL SUMMARY

The Patient Financial Representative is responsible for supporting departmental efficiencies and clinic front office operations by performing all aspects of insurance coverage verification, collections and reimbursement duties for services rendered in a prompt and efficient manner. The duties of this position focuses on the consumer's financial responsibility at time of service. PFRs work behind the scenes in back-office operations and are mainly responsible and skilled to perform duties related to consumer's financial responsibility for services provided. Their responsibility includes, but is not limited to, performing focused reviews (pre-audit) of scheduled and unscheduled patients' records to determine financial eligibility, verification of insurance coverage and benefits, obtaining pre-authorizations and identifying patient financial responsibility. The Patient Financial Representative is responsible for ensuring state funded authorizations and patient funding sources are accurately entered in the Electronic Health Record (EHR). Additionally, they employ proper compliant patient liability collection techniques before, during & after date of service; counsel patients and families on insurance, payment issues, account follow-up and payment resolution. The Patient Financial Representative provides thorough, courteous, and professional assistance to internal and external customers in accordance with the Center's Behavioral Principles and Core Values.

ESSENTIAL DUTIES & RESPONSIBILITIES

Essential functions are the basic job duties that an employee must be able to perform, with or without reasonable accommodation. The list of essential functions, as outlined herein, is intended to be representative of the tasks performed within this classification. The omission of a function does not preclude management from assigning essential duties not listed herein if such duties relate to the position.

• Performs focused reviews (Pre-Audit process) of the consumers record prior to service deliver to determine financial status and updates needed.

• Communicates outcome of Pre-Audit to the Patient Services Representatives to be obtained from consumer upon check-in.

• Completes working billing/reimbursement reports, providing proper documentation and making necessary corrections within specified times.

• Verifies consumer's insurance benefits via insurance portals and/or calls to the insurance company. Verifies authorization dates.

• Updates consumer's insurance information in MyAvatar.

• Collects co-pays, deductibles and other out of pocket costs and fees at the time of visit from the Patient Services Representatives at the assigned clinic ftront desk.

• Communicates consumer MAP fees, account balances, co-pays, or deductibles due prior to service delivery. Sets-up financial arrangements with patients as necessary.

• Conducts all phases of the Revenue Cycle Pre-Audit process 3-5 days prior to scheduled appointments and at time of unscheduled appointments. Notates any deficiencies on appointment sheet.

• Conducts CBO Screenings and Referrals.

• Ensures compliance errors are reported to the Business Office Administrator and maintains records and files of documentation supporting billing changes that are directed by Business Office Administrator.

• Ensures quality standards are met and proper documentation regarding patient accounting records.

• Produces and monitors Revenue Cycle reports:

1. Client Ledger

2. BECA Report

• Verifies consumer's insurance benefits prior to service delivery via insurance portals (TMHP, Emdeon and Novitasphere, IDX Financial Review Report, Inovolon).

• Reconciles daily collections and prepares deposit logs accordingly.

• Serves as backup to Revenue Cycle Services functions in the clinic setting.

• Requests insurance authorizations and/or extensions for services prior to service delivery and updates into EHR via Guarantor Submission and/or Termination form.

• Works correspondence and return mail.

• Performs other related duties as required.

MINIMUM ENTRANCE QUALIFICATIONS

Education and Experience

• High School diploma or GED equivalency, AND,

• Two to three (2-3) years' demonstrated experience in billing, insurance verification, electronic health records OR,

• Two (2) years' experience in medical office back-office operations with working knowledge of insurance verification, insurance carrier billing and billing regulations, and collection requirements by payors (i.e. Medicare, Medicaid, Private Insurance, and Maximum Monthly Fee (MMF).

• Additional qualifying experience or completion of coursework at an accredited college or university in a job-related field, may substitute on a year-for-year basis for one year of the required experience or education.

• Experience calculating expected reimbursement according to payer regulations and/or contracts Demonstrated success working in a team environment focused on meeting organization goals and objectives required.

Licenses or Certifications

• None.

Other Requirements

• Must maintain a valid driver's license and automobile insurance coverage, be able to travel as needed, and be able to meet on a consistent basis the driving record requirements of the Company's auto insurance carrier if you drive your vehicle during company business.

• Must maintain required credentials and mandatory training requirements to ensure compliance with all State regulations and CHCS policies.

• Must be able to meet the physical requirements to complete Nonviolent Crisis Intervention (NCI) and CPR training including lifting up to 12 lbs. and supporting up to 55 lbs.; bending, stooping and getting on and off the floor without assistance.

• Nonviolent Crisis Intervention (NCI) is a proven safe and harm-free method of behavior modification. All consumer-facing employees of CHCS must take NCI courses facilitated by the CHCS Training team within the first 45 days of employment.

• NCI is intended to support human service professionals in giving aggressive, disruptive, or out-of-control people the best care and welfare possible, even in the most violent situation.

• NCI training provides staff with the skills to safely recognize and respond to everyday crisis situations that may involve more challenging behaviors. It focuses on prevention and offers proven strategies for safely defusing anxious, hostile or violent behavior at the earliest possible stage.

• Depending on assigned unit/program, applicants for this position must pass a Criminal Justice Information Systems (CJIS) fingerprint-based background check and maintain CJIS eligibility. Due to CJIS requirements related to system access, the following may result in being disqualified for this position: Felony Convictions, Felony Deferred Adjudication, Class A & B Misdemeanor Deferred Adjudication, Class B Misdemeanor Convictions, an Open Arrest for Any Criminal Offense (Felony or Misdemeanor), and Family Violence Convictions.

PREFERRED QUALIFICATIONS

• Bilingual (English/Spanish) preferred. Language Proficiency Pay (LPP) payments are subject to successful testing, certification by CHCS Payroll, and availability of funding. Funding may be renewed in subsequent fiscal years but is not guaranteed.

SUPERVISION

• Job has no responsibility for the direction or supervision of others.

COMPETENCIES FOR SUCCESSFUL PERFORMANCE OF JOB DUTIES

Knowledge of:

• Applicable software applications.

• Insurance verification claims systems and processes.

• Modern office procedures, methods and computer equipment.

• Principles and practices of recordkeeping.

• Principles and practices of reporting claims.

• System databases.

Skilled in:

• Customer service.

• Data entry.

• Organization and time management.

• Performing a variety of duties, often changing from one task to another of a different nature.

• Performing basic mathematical functions such as addition, subtraction, multiplication, division, percentages, and ratios.

Ability to:

• Accurately organize and maintain paper documents and electronic files.

• Compose spreadsheets.

• Dispute claims.

• Effectively communicate, both verbally and in writing.

• Establish and maintain effective working relationships.

• Maintain accurate and complete records.

• Maintain the confidentiality of information and professional boundaries.

• Meet schedules and deadlines of the work.

• Navigate web portals.

• Prepare clear and concise reports.

• Understand and carry out oral and written directions.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to meet the physical requirements to complete Nonviolent Crisis Intervention (NCI) and CPR training including lifting up to 12 lbs. and supporting up to 55 lbs.; bending, stooping and getting on and off the floor without assistance.

• Must have adequate mobility that requires frequent walking, standing, bending, stooping, kneeling, reaching (vertical and horizontal), using fingers, hands, feet, legs and torso in various care.

Monday

• Friday 8:30 am

• 5:30 pm 227 W Drexel

• Bldg A

Code : 3815-4

HOURLY RATE RANGE: $20.00-$25.62