Medstar EMS Patient Access Representative in Summerdale, Alabama

JOB TITLE:

Patient Access Representative

JOB CODE:

BILLER

FLSA STATUS:

Non-Exempt

EEO CODE:

5 – Admin

REPORTS:

Billing Supervisor – Patient Access Representative

BUSINESS UNIT:

Billing/Patient Accounts

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

ESSENTIAL DUTIES AND RESPONSIBILITIES: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • 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.

KNOWLEDGE, SKILLS & ABILITIES

  • Thorough knowledge of ambulance transport documentation.

  • Extensive knowledge of ICD-9 and Condition Codes.

  • Ability to collect for healthcare claims from MCR/MCD, commercial insurance, contracted facilities, and individuals.

  • Understands Medicare and Medicaid regulations and guidelines.

  • Familiarity with Medicare, Medicaid, Coding, Private Pay, and insurance preferred.

  • Familiarity with medical terminology.

  • Ability to interpret EOB (Explanation of Benefits)Familiarity with Microsoft Office Suite

  • Working knowledge of RightCAD database

COMPETENCIES:

To perform the job successfully, an individual should demonstrate the following competencies:

  • Analytical - collects and researches data; uses intuition and experience to complement data.

  • Design - demonstrates attention to detail.Problem solving - identifies and resolves problems in a timely manner; gathers and analyzes information skillfully.

  • Technical skills - assesses own strengths and weaknesses; pursues training and development opportunities; strives to continuously build knowledge and skills; shares expertise with others.

  • Customer service - responds promptly to customer needs; solicits customer feedback to improve service ; responds to requests for service and assistance; meets commitments.

  • Interpersonal skills - maintains confidentiality; listens to others without interrupting.Oral communication - speaks clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions; participates in meetings.

  • Written communication - writes clearly and informatively; presents numerical data effectively; able to read and interpret written information.Teamwork - balances team and individual responsibilities; exhibits objectivity and openness to others' views; gives and welcomes feedback; contributes to building a positive team spirit; puts success of team above own interests; able to build morale and group commitments to goals and objectives; supports everyone's efforts to succeed.

  • Quality management - looks for ways to improve and promote quality; demonstrates accuracy and thoroughness.

  • Diversity - shows respect and sensitivity for cultural differences; promotes a harassment-free environment.

  • Ethics - treats people with respect; keeps commitments; inspires the trust of others; works with integrity and ethically; upholds organizational values.Organizational support - follows policies and procedures; completes administrative tasks correctly and on time; supports organization's goals and values.

  • Judgment - exhibits sound and accurate judgment; supports and explains reasoning for decisions; includes appropriate people in decision-making process.

  • Planning/organizing - prioritizes and plans work activities; uses time efficiently; sets goals and objectives.Professionalism - approaches others in a tactful manner; reacts well under pressure; treats others with respect and consideration regardless of their status or position; accepts responsibility for own actions; follows through on commitments.

  • Quality - demonstrates accuracy and thoroughness; looks for ways to improve and promote quality; applies feedback to improve performance; monitors own work to ensure quality.

  • Quantity - meets productivity standards; completes work in timely manner; strives to increase productivity; works quickly.

  • Safety and security - observes safety and security procedures.

  • Adaptability - adapts to changes in the work environment; manages competing demands; changes approach or method to best fit the situation; able to deal with frequent change, delays, or unexpected events.

  • Attendance/punctuality - is consistently at work and on time; ensures work responsibilities are covered when absent; arrives at meetings and appointments on time.Dependability - follows instructions, responds to management direction; takes responsibility for own actions; keeps commitments; completes tasks on time or notifies appropriate person with an alternate plan.

  • Initiative - volunteers readily; undertakes self-development activities; seeks increased responsibilities; asks for and offers help when needed.

  • Innovation - generates suggestions for improving work.

EDUCATION AND RELATED WORK EXPERIENCE

  • High school diploma or general education degree (GED)

  • Minimum of 2-years medical billing experience with a high volume practice or clinic, ambulance experience preferred.

  • Combination of education and experience considered.

LICENSES, REGISTRATIONS or CERTIFICATIONS

  • Ambulance/Medical billing certification or diploma preferred.

REPORTING RELATIONSHIPS & DIRECTION/GUIDANCE

This position reports directly to the Operations Manager and is a dotted line report to the Director of Revenue Cycle.

BUDGET AND OR RESOURCE RESPONSIBILITY

This job has no budgetary responsibilities.

PHYSICAL REQUIREMENTS, COGNITIVE FUNCTIONS & WORKING CONDITIONS: The physical demands, work

environment factors and cognitive functions described below are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

PHYSICAL REQUIREMENTS:

This position requires frequent sitting, occasional walking, standing, stooping, bending and twisting of the neck, bending and twisting from the waist, and reaching overhead. This position requires frequent fine manipulation and simple grasping of both right and left hands (e.g. typing, holding telephone receiver, and utilizing writing implements.) This position requires occasional lifting of no more than 50 lbs. This position requires close vision (clear vision at 20 inches or less) and the ability to adjust focus.

COGNITIVE FUNCTIONS:

This position requires the ability to compare, analyze, copy, communicate, coordinate, instruct, compute, synthesize and evaluate. This position requires strong negotiation and interpersonal communication skills.

Language Skills: Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.

Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and/or percent.

Reasoning Ability: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.

TYPICAL WORK ENVIRONMENT:

Temperature controlled office environment of quiet to moderately quiet sound level.

Lifeguard Ambulance Service is an affirmative action/equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, age, status as a protected veteran, among other things, or status as a qualified individual with a disability.