Job Description:

Facility: Spalding Medical Center


Job Summary: This position represents WellStar facilities in financial matters pertaining to communication with patients and insurance companies, appropriately documenting and reporting payment information, educating patients regarding available payment options, financial assistance or other available services. Has a working knowledge of the rules and regulations pertaining to government programs to include appeals and hearing requests. Responsible for updating patient account information during pre-admission, inpatient, and outpatient phases of the patient's visit. Screens In-house referrals within a defined timeframe. Files patient applications with applicable government agency/program. Collect and submit verifying documents necessary for application approval and follow up as needed until final approval is received. Review application denials with patient and file timely appeals. Field visits may be required as needed to contact patient to obtain missing or incomplete information. Possess the ability to communicate with hospital case managers, social services and admissions staff on screening determination outcomes. Provide detailed documentation in the electronic system of application status or pertinent details of a case. Acts as intermediary with Admitting, Business Office, patients and family members while the patient is hospitalized. Maximizes point of service collections by addressing and resolving patient liability balances, current and outstanding prior to or by patient discharge. Minimizes financial risk for the patient and for WellStar Health System to identify the correct insurance plan, plan type, and WellStar's network participation. Coordinate appropriate notification and verification to obtain precertification or authorization for services rendered as applicable. Strong customer Service skills are required, as well as the ability to communicate effectively with internal and external customers to include patients, families, insurance providers and Physicians. Identify and offer any discount programs for which the patient may qualify based on services and location. Identify any applicable alternative sources of payment and provide referrals and or applications to state, federal or other local agencies that may provide financial assistance as applicable for the services and the service location. Follows established internal policies and procedures for processing payments, receipts, cash handling etc. Strong organizational skills are required. Sorts, files and maintains various documents and electronic records.. Assists with general hospital information and directions to departments both internally and externally . Dresses in appropriate business attire. Strong verbal and written communication skills are required. Responsible for responding to patient inquiries regarding charges and account settlement. Core Responsibilities and Essential Functions: Financial - Collects the estimated financial responsibility for current services as well as any outstanding guarantor balances, regardless of patient class at the earliest possible collection control point. - Monitors in-house accounts and makes financial arrangements with guarantors for payment of their full financial responsibility prior to discharge. - Communicates with Medicaid Eligibility Vendor to determine eligibility and approval/ denial status, as needed. For discharged referrals, contact by phone or letter within 10 days of referral. - Completes financial evaluation forms to document guarantors' income, expenses, assets and liabilities. - Identifies those patients without adequate insurance coverage. Makes personal contact with guarantor to determine guarantor's ability to pay non-covered charges, as well as to determine potential eligibility for financial assistance programs. (i.e. Medicaid). - Maintains a list of health care financial assistance programs and the eligibility requirements for each program. Refers patients/guarantors to sources of outside funding assistance, distributes financial assistance (i.e. Medicaid) applications as needed. - Works efficiently and accurately within designated time frames to ensure a continuity of information and cash flow. - Interviews guarantors at time of registration, or at least within 24 hours of admission, to verify complete insurance and financial information. Explain financial options,and collect the estimated financial responsibility. - Documents concise and understandable notes regarding all collection activity, as well as each patient or guarantor interaction. Documents all efforts to collect guarantor account balances, other self-pay collection activities and referrals to Medicaid. - Coordinates financial counseling activities with Admitting, Outpatient Registration, Emergency Registration, Utilization Review, Nursing, Social Services, and Patient Financial Services. - Verifies insurance coverage and benefits. - Consistently meets or exceeds department productivity standards. Formally reports results of collection activity to direct supervisor, daily or according to policy. Provides feedback to PAS management concerning collection and data integrity issues. - Responsible for completion of appropriate errors and issues in Workqueues. Quality/ Safety - Reviews daily census and/or applicable workqueues and visits hospital patients when appropriate, verifies patient coverage, benefits, and collects estimated patient liable amounts. - Interviews each patient or representatives to obtain complete and accurate demographic, financial and insurance information. - Obtains all necessary signatures and is knowledgeable regarding any special forms that may be required by the patients third-party payer. - View charges to determine financial estimates and collects appropriate co-pays/ and or deductibles. - Makes corrections and updates patient account information in computer. - Documents thorough explanatory notes on patient accounts, concerning any non-routine circumstances, clarifying special billing processes. - Maintains a working knowledge of available information system capabilities and performs all system applications that are required. - Understands and applies WHS philosophy and objectives, and WellStar and any departmental. policies and procedures, as related to assigned duties. Understands the admission, outpatient and emergency registration process. - Maintains confidentiality of patient information, in accordance with WHS policy and HIPPA regulations. - Consistently demonstrates the ability to organize work. - Recognizes and establishes appropriate work priorities and completes work in a productive manner. - Maintains proficiency in data entry skills. - Assists with Medicaid screening on all accounts. - Resolves errors in assigned Workqueues. Customer Service - Greets all guest with a positive and professional attitude. - Answers incoming phone calls and follows through with requests made. - Maintains courteous and cooperative working relationships with WHS management, patients, physicians, other professional contacts, and the public. Demonstrates ability to tactfully handle difficult situations. - Presents a well-groomed and professional image in coordination with dept/ hospital dress codes. - Uses appropriate telephone etiquette and scripting. - Is flexible with work hours to meet department needs - Meets service recovery and customer service guidelines - Stays current and conveys knowledge of various insurance plans to customers as needed. - Works well with Team Members and understands appropriate department process. - Identifies and requests additional information as needed to complete authorization requests Expected Performance, Behaviors and Results: The WellStar Experience (Must demonstrate a commitment to Service Excellence by): - Creating first impressions, memorable moments and impressions that fulfill the expressed and unexpressed wishes and needs of patients and family members. - Valuing patients and family members as partners in their care. - Having world-class processes in place. - Delivering high-touch care that is reliable, responsive and coordinated. - Focusing on constant innovation and creating improvements. - Celebrating our diversity with sensitivity and understanding. - Embracing the idea that we are all owners of our health system. General - Adheres to scheduled work hours and provides proper notice of absences, tardies and any other work schedule changes. - Cross-trains in all areas of registration. - Attends departmental meetings at the request of WellStar Management. - Completes all required and/or mandatory training. - Maintains multiple login credentials to utilize various tools to access third-party and insurance web portals for insurance verification and precertification processes. - Performs other duties as assigned. Required Minimum Education: High school diploma Required or GED Required and Bachelor's Degree Preferred Required Minimum License(s) and Certification(s): All certifications are required upon hire unless otherwise stated.

• Certified Patient Account Rep

Additional License(s) and Certification(s): Georgia HFMA (Hospital Financial Management Association) or similar within 12 months of hire date. Required Required Minimum Experience: Minimum 2 years At least two years of related experience, in a healthcare or institutional work setting. Worked in healthcare setting performing Insurance verification and prior authorizations. Required and Demonstrated ability working in the Epic Electronic Health Record. Required Required Minimum Skills: Typing or data entry competency of 40 words/minute. Cash handling and balancing. Demonstrated professionalism, effective verbal and written communication skills and active listening skills. Proficiency using Microsoft Office Suite (WORD, Excel, PowerPoint, Access, Outlook) Apply Now