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Inspire health. Serve with compassion. Be the difference. Job Summary Understands the overall organizational goals for timely and appropriate resolution of accounts. Works in accordance with Patient Friendly standards consistent with policies and procedures ensuring complete, accurate, and compliant processes resulting in optimal collection and customer service performance for the organization. This includes the collection of deductibles, co-pays and co-insurances as well as payment towards accounts classified as self-pay. In depth deomgraphic and financial assessments are performed, generally at the bedside, and analyzed to determine an appropriate payor source. Follow up form the assessment may include the need to assist the patient and contact outside agencies such as Vocational Rehabilitation, Department of Health and Human Services, Social Security Administration and others. The position works collaboratively with Social Work and Outcomes Management to support their initiatives with ensuring the most appropriate continuum of care for the patient.
Essential Functions
Interviews patient and/or patient's representative (in accordance with HIPPA Guidelines) to obtain complete and accurate demographic and financial information. Possesses and demonstrates knowledge of computer systems and financial counseling processes allowing the ability to follow through with all assigned accounts timely and accurately to the satisfaction of the internal and external customer. Exercises judgement in analyzing the information collected and following through to ensure the patient receives every consideration for financial assistance. Ensures elimination of all possible payor sources prior to consideration of hospital sponsorship. Communicates patient's estimated financial responsibility and requests payment prior to or at the time of service; appropriately explaining insurance terms to the patient. Receives payments and issues receipts in accordance with departmental cash handling procedures. Continually excels at the performance benchmark standards. Monitors high dollar accounts that represent significant exposure to ensure complete and accurate financial and demographic information necessary for timely submission and reimbursement of the account. Initiates authorization and insurance verification processes as necessary and communicates changes to those departments who need to be made aware. Coordinates and delegates referrals to the Department of Health and Human Services for an application to be completed. Monitors to ensure applications are secured in a timely manner. Demonstrates superior interpersonal relationship skills necessary for developing and maintaining positive professional relationships with patients, peers, clinical departments, payor organizations, and industry organizations. Maintains superior revenue cycle knowledge through an ongoing review of governmental, managed care and other third-party payor regulations and guidelines. Explores any possible payor source options such as Cobra, Liability, Worker's Compensation or other Governmental Agencies. Participates in appropriate departmental training and career developmental opportunities. Contacts Social Security Administration and makes appointments for patients as needed. As needed, assists the patient with the interview process and completing required forms. Facilitates the disability determination process by working with the clinical staff and disability examiner to gather information needed for a disability determination to be made. Exercises superior judgement in coordinating referrals to the appropriate outsource vendor for cases which may require additional follow up once the patient is discharged from the hospital. Completes special projects related to the revenue cycle as assigned. Including but not limited to participation with the complex patient review team, coordinating processes with Communicare and assisting with financial counseling functions at other facilities. Exercises superior judgement in the elevation and determination of issues to be escalated to the appropriate management (internal/external). Performs other duties as assigned.
Supervisory/Management Responsibilities
Minimum Requirements
Education - High School diploma or equivalent OR post-high school diploma/highest degree earned Experience - 3 years - Health Care Revenue Cycle Experience (such as Billing, Collections, and/or Customer Service)
In Lieu Of
Required Certifications, Registrations, Licenses
Knowledge, Skills and Abilities
Work Shift Day (United States of America)
Location Cancer Centers - Faris Road
Facility 1008 Greenville Memorial Hospital
Department 10559151 Revenue Cycle-Cancer Institute-CIF
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.
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Prisma Health
Nov 15, 2024