Patient Access Rep III

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. & from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.

Assist in providing access to services provided at the hospital. Knowledge of all tasks performed in the various Verification/Pre-certification area is necessary to provide optimum internal and external customer satisfaction and provide the opportunity for accurate reimbursement. The position basic function is for the verification of eligibility/benefits information for the patient’s visit, obtaining Pre-cer/Authorization/Notifying Third Party payers within compliance of contractual agreements with a high degree of accuracy. Participates in upfront collections by informing the patient of the estimated patient portion during insurance verification.  Responsible for establishing the hospital’s financial expectation for the patient and/or guarantor and ensuring accurate information is exchanged which determines whether the account will be processed in an efficient and expedient manner for the hospital and the patient.

1. Obtains detailed patient insurance benefit information

  2. Discusses benefits and other financial issues with patients and/or family members during initial evaluation.

  3. Advises patients on insurance and billing issues and options. Serves as a resource for patients and their family members on financial matters.

  4. Coordinates all necessary payer authorizations

  5. Consistently monitors and updates information regarding insurance data, physicians, authorizations and managed care contracting.

  6. Assists patients and their families with questions concerning insurance and other financial issues.

  7. Identifies and effectively communicates financial information team members, patients and their families with emphasis on identifying any potential patient out-of-pocket liability.

  8. Works with patients, their families and team members when possible to help address insurance coverage gaps via alternative funding options.

  9. Facilitates resolution of patient billing issues

  10. Ensures payers are listed Accurately, pertaining to primary, secondary, and/or tertiary coverage and billing when a patient has multiple third party/governmental payers listed on an account

  11.  Process patient accounts and deploy established policies to resolve insurance issues with patient accounts

  12.  Initiate pre-cert for in-house patients when required, obtaining pre-certification reference number, approved length of stay, and utilization review company contact person and telephone number

  13. Notify hospital Case Managers on all in-house patients regarding insurance plan changes/COB order, out of network plans, and Medicare supplemental plans that require pre-certification

  14. Contact physician’s on scheduled patients, to notify them of authorization requirements and any possible financial holds

  15. Analyze reports to ensure admission dates for patient type changes are accurate in order for the account to appear on insurance verification reports

  16. Maintain and update reference notebooks on insurance companies, employers, pre-certification requirements, etc to stay current on changes within the insurance industry

  17.May function as team lead to ensure smooth operation of daily activities.  This may include assisting with coverage, scheduling, providing feedback, and quality assurance

Education and Licensure

*High School Diploma/GED

Minimum Experience
*Two (2) years of related experience

Minimum Knowledge, Skills, and Abilities

*Extended knowledge of HMO’s , PPO’s, Commercial/Governmental payers and System/Entity specific hospital contracts with Third Party payers

*Extended knowledge of HIPPA and EMTALA