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Patient Coverage Rep
Major Responsibilities:
Licensure, Registration, and/or Certification Required:
Education Required:
Experience Required:
Knowledge, Skills & Abilities Required:
Physical Requirements and Working Conditions:
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
- Provides telephonic training support to assist team members with scheduling, registration and check-in related policies and procedures, including patient, account, and coverage level inquiries. This support is frequently offered when a patient is with the team member, necessitating both speed and accuracy in the assistance.
- Maintains particular expertise in insurance coverage and guarantors
- Provides advanced level of knowledge regarding creation and maintenance of specialty accounts (Workers Compensation, Third Party Liability (TPL), Special Programs, Direct Bill, etc.).
- Reviews and resolves guarantor account discrepancies, ensuring billing information is accurate and compliant with privacy regulations.
- Assists front line team members with inquiries regarding patient payments, ensuring they are applied to guarantor accounts accurately and any discrepancies are resolved appropriately using defined reconciliation processes.
- Receives Customer Relationship Management requests (CRM’s) from various departments containing requests from patients regarding insurance and guarantor discrepancies.
- Assists team members with advanced questions/issues regarding resolution of transactions in various workqueues, including those relating to Schedule Order, Referral and Patient.
- Gathers information and trends to identify process improvement opportunities. Collaborates with leadership and Revenue Cycle Training, Quality & Systems, and Workflow Optimization to provide on-going education to team members.
- Supports and resolves MyChart inquiries regarding registration related questions and updates.
Licensure, Registration, and/or Certification Required:
- None Required.
Education Required:
- High School Graduate.
Experience Required:
- Typically requires 2 years of experience in health care registration, insurance, and billing. Experience as a front desk team member strongly preferred.
Knowledge, Skills & Abilities Required:
- Substantial knowledge base and understanding of health care scheduling, registration, payment collection, billing, and insurance follow-up procedures.
- Knowledge of Medicare, Medicaid, and Commercial payors.
- Proficiency in the in-scope electronic health record system(s).
- Strong analytic, organization, communication (written and verbal), and human relations skills.
- Ability to work both independently and as part of a team to troubleshoot and problem solve quickly and efficiently.
- Previous data entry experience and demonstrated proficiency with emphasis on speed with accuracy.
Physical Requirements and Working Conditions:
- Sits the majority of the workday.
- Must be able to lift up to 10 lbs. occasionally.
- Operates all equipment necessary to perform the job.
- Exposed to a normal office or home office environment.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
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