Mercy Medical Center Clinton Insurance Verification Representative in Silver Spring, Maryland
This position is the third in a series of three that are involved in registration, admission, bed management, financial clearance and cash collection for provided services. Ensures expedient payment of hospital bills by verifying information gathered during the registration/admission process is accurately presented to third party payers or guarantors, and minimizes errors that would result in penalties or other delays in payments to the hospital. Ensures cash reconciliation and submission activities are completed in a timely manner. May perform the duties of a Patient Registration Representative I and II.
Contacts insurance carriers and/or reviews information from insurance verification systems to determine insurance coverage and eligibility. Resolves problems, coordinates benefits and payments for services by more than one source and/or from primary/secondary carriers. Updates patient accounts with appropriate insurance payer codes, authorization or treatment numbers and calculates number of inpatient days approved.
Reviews and updates demographic/insurance information and account status to ensure accounts meet payer requirements/timeframes for billing and payment. Ensures data quality standards are met through quality monitoring and report reviews.
Makes final determination whether patients meet hospital financial/insurance eligibility criteria. Coordinates activities with physicians, case management, insurance carriers, HMO’s, other third party payers, and patients regarding each admission/registration. Notifies appropriate physician/department/patient when eligibility criteria are not met and offers alternative options (Refer patients to Financial Counselor). Provides demographic/insurance or other related information to Holy Cross departments, e.g., the Social Work Department and other physician/providers, as needed and according to department procedure.
The PRR III will determine, collect and document required patient obligations/deductibles at the time of service. This must always be done with the highest level of customer service.
Conducts follow-up with patients involved in accidents or their representing attorneys to obtain required insurance, accident and other financial information for the admission/registration. Works with workers compensation departments, employers to complete and update all worker compensation claims.
Knows and adheres to government regulations relative to Medicare Secondary Payer (MSP) screening, Advance Beneficiary Notice (ABN) and Ambulatory Payment Classification (APCs).
Reviews/explains bill(s) to patients and/or third party payers. Requests corrections for any billing mistakes. Maintains patient confidentiality and adheres to the hospital’s privacy and security policies at all times.
Supports the Mission of Trinity Health and Holy Cross Hospital.
Minimum Licensure/Certification Required (if applicable):
Certified Healthcare Access Associate (CHAA) or equivalent preferred. Minimum Knowledge, Skills, and Abilities Required:
High school graduate or GED equivalent.
Ability to communicate clearly and effectively in both verbal and written form. Fluency in both English and Spanish preferred. Spanish may be required for this position in specific settings.
Two years experience in a hospital and/or other health care setting, preferably in registration, billing, cash collections or insurance requirements. Familiarity with third party/insurance payers and medical terminology preferred. Related college level courses may be considered in lieu of work experience.
Proficiency in the use of computers. Specifically, Microsoft products and email.
Basic knowledge of formulas, charts and tables and their applications.
Ability to prepare and analyze reports and registration data.
Typing skills of 45 wpm or higher required.
Excellent public relations and customer service skills. Excellent telephone customer service skills. Strong interpersonal communication, problem solving and organizational skills.
Ability to work in a fast paced environment with frequent interruptions.
Self-directed and ability to prioritize work in a stressful environment.
Ability and willingness to transport patients by wheelchair.
Ability to meet patient age-specific needs
Physical Requirements : Medium work. Exerting up to 50 pounds of force occasionally, and/or up to 30 pounds of force frequently, and/or up to 10 pounds of force constantly to move objects.
Visual Acuity : The worker is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading; visual inspection involving small defects, small parts, and/or operation of machines (including inspection); using measurement devices; and/or assembly or fabrication parts at distances close to the eyes.
Environmental Conditions : None. The worker is not substantially exposed to adverse environmental conditions (such as in typical office or administrative work.)
Functions with minimal supervision, utilizing current information and resources, and setting work priorities according to assigned workload.
Communicates with Supervisor regarding unusual situations or patient status
Holy Cross Health is an Equal Employment Opportunity (EEO) employer.
Qualified applicants are considered for employment without regard to Minority/Female/Disabled/Veteran (M/F/D/V) status
Trinity Health's Commitment to Diversity and Inclusion
Trinity Health employs about 133,000 colleagues at dozens of hospitals and hundreds of health centers in 22 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.
Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 94 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities, and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually.
Based in Livonia, Mich., and with annual operating revenues of $17.6 billion and assets of $24.7 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity Health employs about 133,000 colleagues, including 7,800 employed physicians and clinicians.
Committed to those who are poor and underserved in its communities, Trinity Health is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services — ranked by number of visits — in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs. For more information, visit www.trinity-health.org (http://www.trinity-health.org/) . You can also follow @TrinityHealthMI on Twitter.