To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values-integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
Reviews patient account before and after admission to ensure that patients comply with all third party policies in order to guarantee payment to the hospital. Verifies eligibility and benefits, obtaining authorizations and approvals, and takes all steps necessary to protect the patient and the Hospital from unnecessary financial loss.
Responsibilities: 1. Demonstrates a strong understanding when verifying insurance benefits. When necessary alerts PAR of potential limitation of coverage to determine appropriate methods for payment and possible eligibility for agency assistance. 1.1. Telephones insurance company and/or employer and obtains insurance benefits on each account within 24-48 hours of admission. 1.2. Lists current benefits and pertinent information on each account within 24-48 hours of admission, as well as obtaining prior authorization approvals, second opinions, and pre-certification and coverage for home care services and durable equipment when necessary. 1.3. Enters accurate bill plan information to ensure proper documentation and follow-up before, during, and after patient hospitalization, and ensure timely billing. 1.4. Obtains all UB-92 information and ensures compliance to meet health care regulations that govern hospital billing. 1.5. Demonstrates a thorough understanding of the computer systems (SDK, Groupwise, Online eligibility systems) utilized by the Verification Unit in order to determine insurance eligibility, initial precertifications, and precertification updates. 1.6. Properly routes the account to appropriate parties to hasten the financial clearance process if multiple third parties are present. 2. Provides information to the third parties to determine benefits and obtains the necessary approvals and authorizations to ensure that all managed care accounts can be billed and timely payment received. 2.1. Determines patient's initial approved length of stay by telephone contact with third parties and/or online computer systems. 2.2. Obtains extension of stay information and updates the SDK system following receipt of information to make it available to the PAR, Care Coordinator, and Patient Account Billing Coordinator. 2.3. Ensures that all subsequent follow up activity is established and adheres to a timely schedule. 2.4. Responsible for working provider liable accounts denied due to 'no authorization'. 3. Demonstrates the ability to function independently while exercising good judgement and exhibiting a favorable attitude to s serve the best interest of the hospital. 3.1. Acts as a representative of the Hospital by establishing and maintaining open communication (verbal or written) with Hospital personnel, third party payors, employers, various agencies, and medical personnel to provide both physical and financial well-being of patients, while protecting the financial position of the Hospital. 3.2. Identifies potential bad debt accounts within 7-10 days prior to admission and contacts PAR to determine a course of action to resolve account. 3.3. Determines estimated hospital charges and calculates hospital reimbursement and patient's co-insurance balances. Notifies the PAR of the need for payment of balances not covered by a third party payor 7-10 days prior to admission, during admission or after discharge. 3.4. Documents all activities on SDK system in a clear and concise manner and works SDK messages daily to expedite the financial clearance process.
High School diploma supplemented by business related courses and/or some college.
Two (2) to three (3) years experience in the financial admitting area of Business Services and/or in the Collections area.
Knowledge of third party insurance plans and agency eligibility. Must be able to communicate both orally and written with all levels of individuals within and outside the Hospital.
Incumbent held accountable for the interviewing of admissions and/or discharge; obtaining any additional information necessary to ensure payment of balances not covered by third party payors; contract third party payors, verify coverage and resolve financial problems.
Position requires the application of a variety of policies and exercise of independent judgement in dealing with patients and patients' families; meeting the demands, changing priorities and resolving related problems. Must be able to identify problems and formulate solutions for patient accounts.