Emergency Center Insurance Veriification Representative (S3552)

Company: Holy Cross Hospital
Facility: Holy Cross Hospital at Silver Spring
Department: Central Scheduling & Insurance Verification


General Summary:
This position is responsible for financial clearance, updating demographic patient information and point of service cash collection. The Emergency Center Department Insurance Verification Representative focuses on verification of insurance coverage and point of service cash collection for all registrations and hospital admissions that occur in the Emergency Center Department. Ensures expedient payment of emergency center registrations and hospital admissions by verifying and updating information gathered during the registration/admission process to ensure that information is accurately presented to third party payers or guarantors, and minimizes errors that would result in penalties or other delays in payments to the hospital. Ensures cash reconciliation and submission activities are completed according to department/hospital policies and procedures. May perform the duties of a Patient Registration Representative I and II and Pre- Service Insurance Verification as needed
Contacts insurance carriers and/or reviews information from insurance verification systems to determine insurance coverage and eligibility. Resolves problems, coordinates benefits and payments for services by more than one source and/or from primary/secondary carriers. Updates patient accounts with appropriate insurance payer codes, authorization or treatment numbers and calculates number of inpatient days approved.
Reviews and updates demographic/insurance information and account status to ensure accounts meet payer requirements/timeframes for billing and payment. Ensures data quality standards are met through quality monitoring and report reviews.
Makes final determination whether patients meet hospital financial/insurance eligibility criteria. Coordinates activities with physicians, case management, insurance carriers, HMO s, other third party payers, financial counseling, and patients regarding each admission/registration. Notifies appropriate physician/department/patient when eligibility criteria are not met and offers alternative options (Refer patients to Financial Counselor). Provides demographic/insurance or other related information to Holy Cross departments, e.g., the Social Work Department and other physician/providers, as needed and according to department procedure.
Knows and adheres to government regulations relative to Medicare Secondary Payer (MSP) screening, Advance Beneficiary Notice (ABN) and Ambulatory Payment Classification (APCs).
Reviews and explains hospital bill(s) to patients and/or third party payers. Requests billing corrections for hospital services as necessary. Maintains patient confidentiality and adheres to the hospital s privacy and security policies at all times.
Supports the Mission of Trinity Health and Holy Cross Hospital.

Minimum Requirements:
High school graduate. Two-year college degree or equivalent experience preferred. Ability to communicate clearly and effectively in both verbal and written form. Fluency in both English and Spanish preferred. Spanish may be required for this position in specific settings. Two years experience in a hospital and/or other health care setting, preferably in registration, billing, cash collections or insurance requirements. Familiarity with third party/insurance payers and medical terminology preferred. Related college level courses may be considered in lieu of work experience. Certified Healthcare Access Associate (CHAA) or equivalent preferred. Proficiency in the use of computers. Specifically, Microsoft products and email. Basic knowledge of formulas, charts and tables and their applications. Ability to prepare and analyze reports and registration data. Typing skills of 45 wpm or higher required. Excellent public relations and customer service skills. Excellent telephone customer service skil