Under the direction of the Supervisor, is responsible for all the responsibilities of the Admissions Counselor position which is: ensuring the timely, accurate processing of patient accounts, focusing on the \"up front\" activities. The Admission Counselor verifies and/or collects required data, assuring its accuracy and integrity. Reviews scheduled visits to determine financial requirements. Obtains appropriate preadmission approvals and precertifications, confirming that third party requirements are met, prior to visit. Identifies cases which might place the institution at financial risk and recommends delay or deferral of non-emergent cases until financial issues can be resolved. Maintains account from time it hits Ontrac Work List, until the bill is generated and is responsible for ensuring data quality, in order to expedite billing and reimbursement process and minimize financial risk to the institution.
In addition, the individual will act as a Department resource, which may include assisting in the training of new hires, or the retraining of existing hires. Will act as lead for teams, as assigned, which can vary. Will assist Management team in projects as necessary and assigned.
* Acts as lead to teams, as assigned.
* Runs reports, as assigned.
* Acts as resource for training new and/or existing employees.
* Works projects related to the Inpatient Accounts Department, as assigned.
* Assists in the review of staff denials, as assigned.
* Acts as a Subject Matter Expert for the Department, and may be asked to participate in meetings, as necessary.
* Verifies and/or collects demographic and financial information on all scheduled visits. Enters/edits data on-line as needed, ensuring its accuracy and integrity.
* Contacts insurance companies, managed care plans and outside agencies to verify insurance coverage and benefits. Determines if any pre-admission/pre-visit requirements exist.
* Compiles and submits clinical information required to obtain preadmission approvals precertification. Monitors pending cases to ensure that approvals are obtained prior to visit.
* Makes appropriate referrals to Patient Financial Services Department.
* Recommends delay or deferral for non-emergent cases until financial issues can be resolved.
* Reviews and follows-up on all emergency and unscreened admissions as soon as possible, but within 24 hours at the latest, to identify and minimize financial risk to the institution.
* Maintains patient confidentiality and privacy by accessing patient information only to the extent necessary to fulfill assigned duties. All patient information must be kept private, confidential and secure. All lists, reports, files and documents must always be properly secured and stored. Interviews and examinations should be conducted in such a manner as to afford the patient reasonable audio and visual privacy.
* Maintains effective working relationships and communicates regularly with Social Service, Care Coordination and other departments to update and exchange pertinent account information.
* Adheres to Customer Service Standards by demonstrating professionalism, alertness, helpfulness, and receptiveness to all patients, visitors and other staff members.
* Employs discretion when leaving answering machine messages, or sending faxes.
* Performs special projects as assigned.
* Bachelor's degree or equivalent preferred; high school diploma required.
* Proven experience in like setting is acceptable in lieu of educational requirements.
* 3-5 years' experience in a hospital setting, experience with prior authorizations, billing and reimbursement helpful
* Interpersonal relationship skills necessary to communicate effectively with patient/family, physicians and their support staff, medical staff, nursing staff, other hospital personnel and many external organizations and agencies.
* The technical knowledge of specific legal and regulatory requirements and an understanding of complex third party and medical assistance polices and procedures.
* Knowledge of the hospital information system with emphasis on accounts receivables programs.
* Ability to function independently and prioritize work within established policies.
* Requires good judgment, tact, sensitivity and the ability to function in a stressful environment.
* Ability to maintain confidentiality regarding the patients, their medical histories, demographic and fiscal information, etc.
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.