Provides seamless pre-registration based on HIPAA guidelines prior to service for scheduled ambulatory appointments and hospital scheduled admissions. Completes insurance verification. Documents any out-of-pocket expenses and acquire any necessary referrals. Conducts outbound calls to patients to complete the pre-registration process which consists of utilizing the department scripting which includes patient identification, customer service, registration and explanation of benefits prior to date of service. Reviews insurance benefits with patient and attempts to collect copays, deductible, and coinsurance along with outstanding balance and pre-service payments to contribute to department point of service collections.
The expectation is that a complete and accurate pre-registration is done while maintaining HIPAA guidelines when contacting the patient via phone to verify the demographics and insurance information.
The Financial Clearance Specialist will also discuss any out-of-pocket expense along with any outstanding balance or pre-service payment with an attempt to collect on these services.
If the patient is requestingpayment options, the call can be transferred to department Financial Counselors.
Complete insurance verification for various payers by utilizing passport and manual processes to ensure patients electronic medical record contains the accurate insurance information.
For those insurances that cannot be processed through automated systems a phone call is placed to the insurance carrier to obtain eligibility and out-of-pocket expenses.
Reviews and selects the appropriate insurance and visit indicator to ensure the correct insurance is billed for cadence appointments.
For Hospital scheduled admission appointments the correct coverage would need to be prioritized and then listed on the HAR to ensure correct insurances are being billed.
Review and or request referrals as needed for future appointments by sending telephone encounters to Geisinger Primary Care Provider's(PCP) and contacting outside PCP offices by fax to request referrals.
Completes Medicare Secondary Payer Questionnaire for all patients meeting the criteria.
Enter Financial Comments and Financial Clearance indicator in the appointment info tab in applicable softwar systemutilizing the financial abbreviations to advise staff what has been completed with the account.
Information would consist of demographics status, insurance verification, referrals and any necessary forms that need to be signed by the patient.
Once all information has been captured the demo date is required to be updated with the current date.
For Hospital Scheduled Admissions documentation is completed in authorization and certification tab utilizing departmental smart phrases as well as to document any imperative information pertaining to the account.
The department smart phrases are used to document insurance verification, payments, and pre-registration.
The document table is used to advise staff of the status of the account.
For patients with limited benefits and or no insurance an email is sent to the departmental Financial Counselors for further review.
Advises supervisor of unusual circumstances, situations or issues to get them resolved.
Reviews and explains all necessary forms that require signatures from patients upon arrival such as Assignment of Benefits (AOB), Universal Auth (UA), Privacy Acknowledgment (PACK), Notice of Financial Responsibility (NOFR).
Assists with providing quality assurance for new employees in regards to insurance verification and completed pre-registrations.
Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job. *Relevant experience may be a combination of related work experience and degree obtained (Associate's Degree = 2 years; Bachelor's Degree = 4 years).
High School Diploma or Equivalent (GED)- (Required)
Minimum of 5 years-Relevant experience* (Required)
Certification(s) and License(s)
Certified Healthcare Access Associate - Default Issuing Body
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.
We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh FoodFarmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencingprograms, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 1...3 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers. What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.