Summary:
Accurately collects information from multiple sources to process referrals for outpatient therapy. Analyzes and records the required demographic, insurance, and clinical data sets, other information, and signatures necessary to schedule and pre-register outpatient therapy patients and ensure that bills are produced according to regulatory and payer requirements. Effectively completes medical necessity and managed care requirement screening, and determines insurance type and eligibility to ensure maximum payer compliance is maintained and maximum reimbursement is secured. Verifies and/or authorizes insurance as assigned. Interacts in a customer focused manner during referral processing to ensure that the patient's and their representative's needs are met, and that they understand their personal liabilities through various payment and program options. Demonstrates complete understanding and knowledge of all processes and procedures related to insurance verification, insurance prior authorization, and registration. Performs all insurance verification and communicates appropriate verbal and written explanations to patients, family members, and/or other appropriate parties. Assists in prevention of retroactive denials. Works cooperatively with other departments and outpatient staff/leadership to assure financial reimbursement for outpatient therapy services.
Essential Job Responsibilities:
* Accurately collects and analyzes all required demographic, insurance, guarantor and clinical data elements necessary to process/pre-register outpatient therapy referrals and schedule all types of patients; records and electronically enters the information on a timely basis. Verifies and/or authorizes insurance.
* Accurately prepares, produces, and distributes to other internal and external parties as appropriate and on a timely basis, forms, schedules, and supportive clinical documentation.
* Reviews physician referrals/orders and other documentation according to internal policy and regulation as applicable, in order to assure that the service being provided has been appropriately documented and meets all known payer medical necessity and other criteria. Initiates contact to physicians and other office staff to resolve questions and problems. Initiates and explains the Advance Beneficiary Notification process as necessary. Alerts appropriate parties for any ongoing monitoring or authorization needs.
* Provides information and explanations to the patient or responsible party regarding the policy and various options for resolving the patient's financial responsibility for non-covered services prior to the service being provided.
* Receives and properly responds to telephone, electronic, or face-to-face inquiries from patients or their representatives.
* Reviews and analyzes all referral information and transaction edit reports in order to correct errors and resolve deficiencies.
* Accurately completes therapist planned/unplanned coverage per department protocol.
* Performs all other appropriate activities as necessary to meet the patient's needs and to achieve the required departmental and organizational outcomes. Assists patients/families in keeping scheduled evaluations by providing transportation resources and/or securing translators as necessary.
* Accurately interprets referrals and patient scheduling communication sheets and develops ongoing outpatient therapy schedules. Assures therapist consistency, accuracy, and timeliness when producing schedules according to established scheduling guidelines. Reschedules appointments as needed.
* Outstanding organizational, interpersonal, communication, and overall customer service skills.
* Ability to interact with professional staff in an appropriate manner.
Mary Free Bed is an equal opportunity employer.
Diversity is all of the ways we differ individually, interpersonally and organizationally. Understanding diversity involves the recognition of cultural and other differences and traditions by identifying and empathizing with differing beliefs and behaviors. Mary Free Bed will use the strength of these differences to improve services to its community.
Mary Free Bed values diversity among the patients, families and communities it serves. Creativity and sensitivity to individual needs and differences are valued.
Mary Free Bed values diversity among its staff. Staff who share our organizational values are recruited from all areas of the workforce. Mary Free Bed fosters an environment that embraces differences by enhancing the staff s knowledge and experience. Our staff will serve all patients, families and each other with dignity and respect.
Employer's Job# 997
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