The Patient Access Concierge I greets patients and family members, obtains, and verifies demographic, clinical, financial, and insurance information during the (pre)-registration process, accepts point of service payments or provides guidance for payment options, and clears the patient for service delivery. Perform pre registration, insurance verification and financial clearance activities in a variety of settings and for multiple patient types.
Determines need for appropriate service authorizations (pre-certification, third-party authorizations, and referrals).
- Performs pre-registration, insurance verification and financial clearance activities in a variety of settings and for multiple patient types. Communicates frequently with patients/family members/guarantors, and physicians or their office staff in the deployment of key activities. Interviews patients to collect data, initiates electronic medical records, validates and enters data related to procedures, tests and diagnoses. Determines need for appropriate service authorizations (pre-certifications, third-party authorizations, referrals) and contacts physicians and Case Management/Utilization Review personnel, as needed. Obtains and verifies the accuracy and completeness of physician orders for tests and procedures, which includes name, date of birth, diagnosis, procedure, date, and physician signature to minimize risk to hospital reimbursement. Accurately uses the patient search feature to find the correct patient information and disseminates data to clinical systems for patient care. Identifies required forms or templates based on the types of services patients will receive.
- Performs insurance eligibility/benefit verification, utilizing EDI transactions and payer web access, and calls payers directly. Documents information within the patient accounting system through insurance eligibility/benefit verification. Refers accounts identified as self-pay to benefit advocacy resources. Conducts data search of manuals, physician systems, previous accounts or payment source history, when appropriate.
- Provides financial information and patient payment options. Informs patient/guarantor of liabilities and collects appropriate patient liabilities, including co-payments, co-insurances, deductibles, deposits and outstanding balances at the point of pre-registration or point of service. Documents payments/actions in the patient accounting system and provides the patient with a patient estimate of out of pocket costs and a payment receipt in the collection of funds. Acquires necessary documents including patient identification, insurance cards, consent for treatment, assignment of benefits, release of information, waivers, ABNs, advance directives, etc. Identifies need for patient/guarantor signature based on patient encounter/visit. Scans appropriate documents.
Required: High School Diploma
Preferred: Associates Degree
Specify Degree(s): Accounting or Business Administration highly preferred
Required: 1-2 years of previous job-related experience
Details: Past work experience of at least one to three (1-3) years within a hospital or clinic environment, an insurance company, managed care organization or other health care financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting or customer service activities is highly desired. Consideration may be given for commensurate customer service experience in another industry. Knowledge of insurance and governmental programs, regulations and billing processes (Medicare, Medicaid, Social Security Disability, Champus, and Supplemental Security Income Disability), managed care contracts and coordination of benefits is highly desired.