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Job Summary

Responsible for communicating and providing information which meets the payor requirements for initial notification of Inpatient admissions and Observation, timely completion of insurance verification, and authorization related activities to financially secure patient accounts. This includes timely submission of appropriate documentation in order to meet third party payor requirements which helps ensure that Prisma Health receives timely and accurate reimbursement. Collaborates as appropriate with other departments to ensure efficient processes and facilitate problem solving.

Accountabilities

Full Time

Acts as the initial point of contact to all payors for Inpatient admissions and Observation. Includes timely submission of appropriate documentation as required by the payor(s) for the initial authorization/notification purposes.

Ensures appropriate statistical data is obtained for patients in assigned patient population areas; communicating with payors timely and accurately.

Updates and maintains authorization numbers and approved days in registration and/or other applicable systems as appropriate. Secures discharge dates for payers as assigned.

Verifies insurance coverage/benefits utilizing online eligibility or by telephone inquiry to the employer and/or third party payor. Information obtained through insurance verification must always be documented in the system. Ensures insurance priorities are correct based on third party requirements/COB.

Initiates pre-certification process as required according to departmental guidelines.

Interviews patients or representatives (in accordance with HIPAA and EMTALA Guidelines) to secure information relative to financial status, demographic data and employment information when necessary. Enters accurate information into computer database. Accesses Sovera to review ensure the most recent insurance card is on file. Follows up for incomplete and missing information.

Supervisory/Management Responsibilities

This is a non-management job that report to a supervisor, manager, director or executive.

Minimum Requirements

Education - High School diploma or equivalent

Experience - 3 years Revenue Cycle, Patient Access /Billing, Collections and/or Customer Service

Required Certifications/Registrations/Licenses

n/a

In Lieu Of The Minimum Requirements Listed Above

n/a

Other Required Skills and Experience

Medical Terminology

Basic computer skills

Knowledge of office equipment

Proficient computer skills (word processing)

Data entry

Work Shift

Day (United States of America)

Location

1200 Colonial Life Blvd

Facility

Corporate

Department

PreAccess Services

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.