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Role Description

Responsible for communicating and providing information which meets the payor requirements for initial notification of Inpatient admissions and Observation, timely completion of insurance verification, and authorization related activities to financially secure patient accounts. This includes timely submission of appropriate documentation in order to meet third party payor requirements which helps ensure that Prisma Health receives timely and accurate reimbursement. Collaborates as appropriate with other departments to ensure efficient processes and facilitate problem solving.

• Acts as the initial point of contact to all payors for Inpatient admissions and Observation.
• Ensures appropriate statistical data is obtained for patients in assigned patient population areas; communicating with payors timely and accurately.
• Updates and maintains authorization numbers and approved days in registration and/or other applicable systems as appropriate.
• Secures discharge dates for payers as assigned.
• Verifies insurance coverage/benefits utilizing online eligibility or by telephone inquiry to the employer and/or third party payor.
• Documents information obtained through insurance verification in the system.
• Ensures insurance priorities are correct based on third party requirements/COB.
• Initiates pre-certification process as required according to departmental guidelines.
• Interviews patients or representatives (in accordance with HIPAA and EMTALA Guidelines) to secure information relative to financial status, demographic data and employment information when necessary.
• Enters accurate information into computer database.
• Accesses Sovera to review ensure the most recent insurance card is on file.
• Follows up for incomplete and missing information.

Qualifications

• High School diploma or equivalent
• 3 years of experience in Revenue Cycle, Patient Access/Billing, Collections and/or Customer Service

Requirements

• Medical Terminology
• Basic computer skills
• Knowledge of office equipment
• Proficient computer skills (word processing)
• Data entry

Work Shift

• Day (United States of America)

Location

• 1200 Colonial Life Blvd

Facility

• 7001 Corporate

Department

• 70019073 PreAccess Services

Company Description

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.