DHR Health - US:TX:McAllen - Days
Summary:
FLSA STATUS: Exempt Non-Exempt
MISSION STATEMENT:
Our Mission is to improve the well-being of those we serve with a commitment to excellence: every patient, every encounter, every time.
VISION:
Our Vision is to create a world-class health system to advance medicine and increase access for the communities we serve by empowering caregivers to heal through compassion, knowledge, innovation, integrated care and excellence.
POSITION SUMMARY:
This position will determine insurance eligibility, financial status and eligibility for registration by reviewing insurance information via phone or online verification, calling third party payers to obtain insurance benefits which include the effective dates of coverage, billing address, pre-existing condition clauses, in and out of network benefits and maximum coverage. Such duties include but are not limited to: Meeting with the patient and explaining their surgery orders and pre-surgical testing needed, scheduling in-office and in-hospital procedures, making sure necessary authorizations have been obtained, data entry into the facility computer system and implementing/participating in the development of new diagnostic testing or programs.
POSITION EDUCATION/ QUALIFICATIONS:
- High School graduate or G.E.D. certificate preferred
Completion of CNA program, Medical Office Specialist, or comparable program preferred
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JOB KNOWLEDGE/EXPERIENCE:
- Two (2) years continuous experience in a busy healthcare office with at least one (1) year insurance verification experience (required); previous surgical scheduling experience is preferred.
- Prefer previous physician office or hospital experience
- Must have Excel, Microsoft suite computer experience and must be able to learn department IS system
- Must have excellent customer service skills
- Medical Terminology, ICD Codes, CPT Codes, HCPCS codes, and Modifier knowledge preferred
- Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly
- Requires reasoning ability and good independent judgment
- Requires working with frequent interruptions
- Must project a professional image
- Must be able to be sensitive to cultural and bilingual issues
- Excellent organizational skills are necessary
- Good written and verbal communication skills required
- Ability to read, write and speak English
- Good understanding of insurance benefits, surgical orders and medical terminology.
- Ability to communicate clearly and concisely with all levels of nursing, administration, patients and physicians
Responsibilities:
POSITION RESPONSIBILITIES:
- Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices
- Schedule Surgeries, for both in-hospital and in-office procedures
- Obtaining Authorization or pre-cert as needed for the above
- Schedule, coordinate and monitor appointments of patients for pre-surgical diagnostic testing and registration
- Forwards a completed copy of schedule with applicable patient benefits to front desk staff and/or MD for collection of applicable deductible and co-pay amounts
- Confirms billing address, pre-existing conditions, in and out of network benefits and maximum coverage
- Reviews and confirms patient's financial information by obtaining the insurance carrier information, benefit information, policy number, group name, group number, and the effective date of coverage
- Ability to reference ICD-9-CM/ ICD-10-CM, CPT from doctor’s order to insurance carrier for eligibility and coverage of procedure
- Reviews and confirms patient's deductibles, co-pays, and co-insurance with insurance carrier
- Ability to identify the appropriate coordination of benefits for insurance carriers
- Utilizes phone or on-line verification systems, i.e. TMHP, Availity, Data Link, internal system, etc., for insurance eligibility and benefits
- Determines financial status, meets with patient and refers patient for financial screening as appropriate
- Ensures referral/pre-authorization/pre-certification requirements have been met
- Reviews physician order for appropriate patient status (Inpatient/Outpatient) before verifying coverage for procedure
- Document clearly and concisely all patient benefit information on accounts through the computer system
- Screen and follow up on patient test results as required
- Has appropriate follow up and contact with hospital or patient if necessary
- When working at the reception desk, checking patients both in and out of the practice properly documenting registration in the computer, as needed
- Ensures patient confidentiality requirements are met in accordance with HIPAA/PHI policies and procedures
- Understand and adhere to managed care policies and procedures
- Perform inventory of supplies and equipment as necessary
- Answer and direct all phone calls appropriately
- Effectively communicates and works well with other team members
- Adheres to assigned projects/tasks, and volunteers for special assignments/projects
- Scans information into the EMR as needed
Other duties as assigned.
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LINES OF REPSONSIBILITIES :
(Chain-of-command)
1. Clinic Manager 2. Director 3. Assistant VP of Ambulatory Clinic Operations
Other information:
CUSTOMER SERVICE:
Provide excellent customer service to all DHR customers. All employees are required to attend the DHR C.A.R.E.S program which outlines the Customer Service Principals including Commitment, Accountability, Respect, Excellence and Service.
AGE SPECIFIC :
Employees must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served in his/her assigned unit. The individual must demonstrate knowledge of principles of growth and development over the life span and possess the ability to assess data reflective of the patient’s status and interpret the appropriate information needed to identify each patient’s requirement relative to his or her age.
AMERICANS WITH DISABILITIES ACT: (ADA) :
A. Essential Duties : Indicated by bold print within performance standards, preceding individual numbered criteria.
The following table provides physical requirements that will be associated with, but not limited to, this position:
Light/moderate lifting up to 20 lbs, from the floor to shoulder height.
Must be able to assist other employees with lifting more than 20 lbs.
Light/moderate carrying up to 20 lbs.
Dual simultaneous grasping
Operating office equipment
Operating mechanical equipment
Ability to read and write
Ability to hear verbal communication without aid
Operating Personal Vehicle
Ability to comprehend written/verbal communication
Other: Ability to deal with stress
B. Working Conditions : The individual spends over 95% of his/her time in an air-conditioned environment with varying exposures to noise. There is protection from weather conditions but not necessarily from temperature changes. The position does have low exposure to malodorous, infectious body fluids from patients and some minimal exposure to noxious smells from cleansing agents.
C. Occupational Exposure: This position has minimal to no exposure to blood, body fluids, or tissues and is an OSHA Category III (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Person who performs these duties are not called upon as part of their employment to perform or assist in emergency medical care or first aid or to be potentially exposed in some other way.
D. Aptitudes : HIGH 1 2 3 4 5 6 LOW
Intelligence: General learning ability: The ability to “catch on” or understand instructions and underlying principles. Ability to reason and make judgments. 3
Verbal: Ability to understand meanings of words and ideas associated with them, and to use them effectively. To comprehend language, to understand relationships between words, and to understand meanings of whole sentences and paragraphs. To present information or ideas clearly. 3
Numerical: Ability to perform arithmetic operations quickly and accurately. 2
Spatial: Ability to comprehend forms in space and understands relationships of plane and solid objects. Frequently described as the ability to “visualize” objects or two or three dimensions, or to think visually of geometric forms. 2
Form Perception: Ability to perceive pertinent details and objects or in pictorial or graphic material to make visual comparisons and discriminations and see slight differences in shapes and shadings of figures and widths and lengths of lines. 3
Clerical Perception: Ability to receive pertinent details and verbal or tabular material. To observe differences in copy, to proofread words and numbers, and to avoid perceptual errors in arithmetic computation. 2
Motor Coordination: Ability to coordinate eyes and hands to fingers rapidly and accurately in making precise movements with speed. Ability to make a movement response accurately and quickly. 3
Finger Dexterity: Ability to move hands easily and skillfully. To work with fingers in placing and turning motions. 3
Manual Dexterity: Ability to move hands easily and skillfully. To work with hands in placing and turning motions. 3
Eye-Hand-Foot Coordination: Ability to move the hand and foot coordinately with each other in accordance with visual stimuli. 3
Color Discrimination: Ability to perceive and respond to similarities or differences in colors, shapes, or other values of the same or different color. To identify a particular color, or to recognize harmonious or contrasting color combinations, or to match color adequately. 3
I have read and reviewed my job description with my supervisor or designee, and I understand the job I am expected to perform.
If applicable ____________ certification will be completed within _________ time frame of hire/transfer date.
Employee Signature: ________________________________ Date: ____________________
Transfer/Hire Date Effective: ________________________.
