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Patient Service Representative

Company: Ascend Talent Solutions
Location: Newark
Posted on: June 24, 2022

Job Description:

Our client is a renowned research and care facility with a focus on corporate social responsibility that needs a Patient Financial Representative who is highly organized with exceptional follow-through to be the central point of contact for all things related to daily office operations. Job Description - With excellent organizational skills, the primary responsibility of the Patient Financial Representative will be to assist the Patient Services team with all activities related to insurance verification and securing authorization. The successful Patient Financial Representative will be highly efficient with the ability to multi-task, adapting standard procedures to process Medicare, Medi-Cal, Workers Comp, and all Managed Care plans as well as State and Federal regulations. Strong internal and external facing communication skills is required to support patient care. Additional responsibilities for the Patient Financial Representative include the following: Responsibilities Include:

  • Completes insurance verification, eligibility and benefit determination process utilizing electronic eligibility system, payer websites, and phone for all insurance plans the scope of the patient financial clearance department and assigned service line.
  • Interprets and documents the appropriate co-pay, deductible, share of cost, co-insurance, benefit levels and/or available days.
  • Contacts patient as appropriate to obtain correct and updated information when necessary.
  • Completes Medicare Secondary Questionnaire as appropriate.
  • Applies authorization rules and requirements for all payors within the assigned work queues.
  • Develops a strong working knowledge of the procedures and diagnosis used in the assigned to ensure authorizations are properly completed for the scope of services that be rendered to the patient.
  • Assesses the data required for authorization and securing sponsorship. Communicates with clinics and referring providers to secure appropriate information to complete an
  • Follows up on pending authorization and referral requests to ensure timely completion and sponsorship for cases in the assigned work queue.
  • Arranges escalation process for clinics and clinicians to complete peer-to-peer appeal reviews payor utilization management when needed.
  • Prioritizes work assigned to ensure that financial risk is minimized and timely completion of are optimized.
  • Identifies risk associated with coverage and benefit issues related to the services that are requested for authorization and escalates these issues to appropriate experts to
  • Identifies risk associated with securing financial clearance prior to service date and escalates clinic and other resources to find an appropriate course of action (e.g. reschedule, cancel, PAFR).
  • Understands the role of financial counseling in securing clearance for cases that do not have secured timely. Properly refers these cases as appropriate.
  • Notifies the department manager with issues, instances of errors, or obstacles to successful of work.
  • Applies strong writing skills to account documentation, email communication and internalPosition Requirements
    • 2 years working knowledge of patient registration and insurance verification and
    • processes in a medical organization
    • Intermediate to advanced knowledge of Microsoft applications (Word, Excel, etc.)
    • Demonstrated communication, customer relations, and organizational skills
    • Ability to multi-task with attention to detail
    • Ability to complete work efficiently and problem solve independently
    • Ability to work well in a team environmentEducation
      • High School diploma or GED equivalent Benefits
        • PTO, PST, Medical, Dental, and Vision

Keywords: Ascend Talent Solutions, Newark , Patient Service Representative, Sales , Newark, California

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