Patient Access Representative

Full Time
Birmingham, AL
Posted 1 month ago

Job Description:

Responsible for verifying insurance and demographics of medical transport patients and obtain authorizations, if necessary, to ensure that all information is correct for billing.

Responsibilities:

  • Verifies insurance to ensure patient is covered and insurance information is accurate; uses websites or calls to payors as available.
  • Ranks insurance in correct order by determining primary, secondary, or tertiary insurance.
  • Responsible for obtaining all pre-authorizations for ambulance and/or wheelchair transportation as required.
  • Stays current with all payor requirements for pre-authorizations.
  • Maintains and ensures all documentation is received (i.e. medical necessity forms) and insurance verified monthly on all repetitive patients.
  • Coordinates with Operations for onsite evaluations for dialysis patients.
  • Maintains a log for review of repetitive patients to ensure PCS is within required span of time – within 60 days from date signed.
  • If forms are not obtained or incomplete, moves account to Incomplete Schedule.
  • Works the Incomplete workflow to secure necessary paperwork. Contacts those who issue medical necessity forms directly. If an issue exists, notifies and works with assigned Marketer after notifying Operational Manager.
  • Provides Patient Call Reports (PCRs) to Coding Specialists by 2 p.m. daily.
  • Acts as a Billing resource to marketing and operational staff regarding medical necessity of transports.
  • Obtains payment information prior to transport for all transports not medically necessary as defined by CMS, Ambulance Provisions, Chapter 10.
  • If co-pay is greater than $100, collects before transport.
  • If distance is greater than 50 miles, collects before transport.
  • For any requested transport in which a patient does not have insurance coverage, appropriate medical necessity forms, or payment as outlined above, Operations Manager must be notified before transport takes place.
  • Maintain HIPAA compliance with regard to billing practices.
  • Creates and maintains a strong team environment through communication, motivation, and consistency.
  • Performs special projects for upper management.
  • Plans and manages multiple projects.
  • Continuously cross-train in other function areas.
  • Other duties as assigned.

Qualifications:

  • High school diploma or general education degree (GED)
  • Minimum of 2-years medical billing experience with a high volume practice or clinic, ambulance experience
  • Combination of education and experience
  • Ambulance/Medical billing certification or diploma
  • Thorough knowledge of ambulance transport
  • Extensive knowledge of ICD-9 and Condition Codes.
  • Ability to collect for healthcare claims from MCR/MCD, commercial insurance, contracted facilities, and
  • Understands Medicare and Medicaid regulations and
  • Familiarity with Medicare, Medicaid, Coding, Private Pay, and insurance
  • Familiarity with medical
  • Ability to interpret EOB (Explanation of Benefits)
  • Familiarity with Microsoft Office Suite
  • Working knowledge of RightCAD database.

Benefits:
Integra Connect, LLC provides a comprehensive benefits plan.

  • Medical/Dental/Vision Insurance beginning the 1st of the month following your date of hire
    • 401k with employer match
    • Paid Time Off
    • Paid Holidays and Floating Holiday

Equal Opportunity Employer

 

 

Job Features

Job CategoryRevenue Management

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