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GENERAL OVERVIEW:
Creates the first impression of Allegheny Health Network’s (AHN) services to patients, families, and other external customers upon arrival. Assume clinical and financial risk of the organization when collecting and documenting information on the patient's behalf. Completes one or more of the following processes (proper patient identification, scheduling, registration, financial clearance, authorization and referral validation, creates estimate, and payment collection when applicable). Connects patient to financial advocacy resources when appropriate, provides or obtains signatures on regulatory paperwork as required. Articulates information in a manner that patients, guarantors and family members understand so they know what to expect and understand their financial responsibilities.
Displays a strong attention to detail, excellent communication skills, empathy, and compassion for patients and their families. Has the ability to multitask, work swiftly under pressure in a high acuity patient environment, and work collaboratively with healthcare professionals. Must stand for long periods of time and use a computer on wheels at bedside. Adheres to all EMTALA guidelines and AHN policies and procedures while performing routine duties. Follows standard and isolation precautions to provide adequate protections for healthcare workers, patients, and visitors.
ESSENTIAL RESPONSIBILITIES
Conducts scheduling, registration, and admitting functions independently at bedside, validates patient demographic data, identifies and verifies insurance information through payor contacts via telephone, online resources, or electronic verification systems utilizing accurate plan code and COB order. Obtains limited clinical data based on service required. Collects and updates all necessary data to ensure timely, accurate bill submission to include workers compensation and motor vehicle claims. Provides or obtains signatures on regulatory paperwork as required. (40%)
Identifies all patient financial responsibilities, calculates estimates, collects liabilities and post payment transactions as appropriate in the ADT system and performs daily reconciliation. Identifies self-pay accounts and documents for follow up by self-pay vendor or financial advocacy department. (20%)
Delivers positive patient experience. Cooperates with patients, all healthcare personnel, and designated external agencies or vendors. Performs any written or verbal communication necessary to exchange information with designated contacts and promote positive working relationships. Maintains focus on attaining productivity standards and recommends innovative approaches for enhancing performance and productivity when appropriate. (10%)
Maintain cohesive working relationships with healthcare personnel to communicate pertinent information such as alias name changes and information blocks to prevent release of information. Practices patient confidentiality. Accountable for accurate registration into electronic health record during system downtime with monitoring and reconciliation of every patient for accuracy. Central resource for registration and problem resolution during evenings, weekends, and holidays. (10%)
Ability to remain calm and professional when faced with stressful situations. Respond to inquiries from patients, visitors, hospital personnel, government agencies, etc. under all circumstances and conditions. (10%)
Adheres to AHN organizational policies and procedures for relevant location and job scope. Completes and/or attends mandatory training and education sessions within approved organizational guidelines and timeframes. (10%)
Other duties as assigned or requested.
QUALIFICATIONS:
Required
High School/GED or one – three months related experience and/or training; or equivalent combination of education and experience
Experience operating a PC and using software applications
One previous year of related experience, preferably within a medical setting, financial services setting, and/or a demanding customer service environment
Preferred
Medical terminology and insurance knowledge
SKILLS:
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
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