Mercy Medical Center Clinton Patient Services Representative - Radiology - Full Time in Saint Joseph Mercy Health System Hospital Campus - Ann Arbor, Michigan
Saint Joseph Mercy Health System, one of the nation's top health care services providers, spanning five counties in Southeastern Michigan. SJMHS represents more than 2,700 physicians and 14,000 nurses and staff, and includes 6 Hospitals, 5 Outpatient Health Centers, 8 Urgent Care Facilities and over 25 Specialty Centers.
An opportunity exists for a Patient Servces Representative to join our Radiology Department
Under limited supervision; determines need for and obtains authorization for treatment/procedures and assignment of benefits required. Provides information to patients concerning regulatory requirements. Provides estimated costs and patient responsibility, facilitating collection of co-pay, deductible and private pay balances. Responsible for the complete and accurate collection of patient demographic and financial information for the purpose of establishing the patient and service specific record for claims processing and maintenance of an accurate electronic medical record. Registers and checks-in patients and determines preliminary patient and insurance liability. Performs account analysis, problem solving and resolution of patient account issues. Initiates billing and rebilling of accounts as appropriate.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
Interviews patients and gathers information to assure accurate and timely claims submission. Interprets information collected to determine and create comprehensive visit-specific billing records. Determines need for and obtains authorization for treatment/procedures and assignment of benefits as required. Maintains competency by participating in on site and external training opportunities. Utilize skills gained from training sessions to improve and enhance their work processes and customer interactions. Provides information to patients concerning hospital policies and regulatory requirements utilizing effective interpersonal and guest-relations skills. Provides assistance to other Health System or physician offices staff regarding registration, insurance verification and authorization requirements and processes. Determines appropriate payment required at point of registration (deposits, co-pays, minimum charges and non-covered services.) Collects payment at time of registration or check-out. Based on planned services provides estimated costs and patient responsibility for both procedural and complex services. Documents communication with patients related to estimates within the patient accounting record. Verifies procedural and diagnosis codes submitted by service departments and physicians to assure accuracy for claims submission and adjudication of reimbursement. Verifies insurance eligibility with payors. Determines benefits and ensures authorization requirement are met. Interacts with ordering practioner and patient to coordinate service and insurance requirements. Contacts patients to discuss eligibility and benefits and requirements specific to clinical services. Creates appropriate registration record. Communicates with patients their financial responsibility, benefit and authorization status prior to clinical services. Facilitate cash collection as appropriate prior to and at the time of service, including copays, deductibles, and private pay responsibility. Obtains insurance authorization, patient liability acknowledgement, acknowledgement of non-covered services and advance beneficiary notices and consent forms. Explains the purpose of these forms to patients and responds to question related to their intent. Completes as required; obtains signatures and approvals; verifies that information is complete and accurate. Is proficient at the use of automated tools and makes appropriate decisions related to the relationship of the action required and the tool used. System tools include: HealthQuest Patient Management and Patient Accounting, Cerner Enterprise Scheduling, Pathways Compliance Advisor (medical necessity screening), Reg Assist (scanning patient documents) EMDEON (eligibility verification, copays), UGS (Medicare), WebDenis (Blue Cross), HAP, Priority Health, NaviNet (Aetna, Cigna), Champs (Medicaid) Community Health Plan (WHP), Iexchange (BCN authorizations), American Imaging (radiology authorizations). Works various reports to ensure accuracy and completion of records to facilitate clean claims submission. Responds to contacts from from Medical Records, Clinical Departments and PFS Teams to ensure appropriate analysis, error correction and process identification in relation to concerns and issues. Reviews, analyzes and corrects system error reports (C9, Reg Error, Cancellation, MSP Bypass etc.) Utilizes Scheduling Booking Reports , Stop/Go Reports, Schedules, to facilitate daily patient activity and flow in support of the clinical departments. Analysze completeness and accuracy of records on these reports proactively and take action as appropriate. Demonstrates understanding and follows prevailing regulatory or 3rd party requirements (MSP, pre-certification, consent forms, HIPAA etc.) Analyze and problem-solves issues related to revenue cycle elements (charges, demographic information, guarantor information, insurance eligibility, coordination of benefits, authorization requirements) in response to patient inquiries and issues. Works to resolves these issues in a timely and appropriate manner including assisting with submission of patient centered claims to insurance carriers. Explains accounts to patients and translates registration and billing issues to patient understanding. Identifies opportunities to improve the quality of registration, billing or verification procedures. Responds to patient questions concerning insurance coverage, benefit coverages for their insurance plans. Demonstrates accountability to follow-up with patients concerning requests for information or action regarding their account. Knows where to obtain information to assist PFS team members, patients, internal and external customers. Assists patients or physician office staff by referring to the appropriate sources of information. Demonstrates team-player abilities and seamless service to patients. Occasionally assist with training of new employees and cross training of other team members. Maintains good rapport and cooperative relationships. Approaches conflict in a constructive manner. Helps to identify problems, offer solutions, and participate in their resolution. Maintains the confidentiality of information acquired pertaining to patient, physicians, employees, and visitors to St. Joseph Mercy Hospital. Discusses patient and hospital information only among appropriate personnel in appropriately private places. Behaves in accordance with the Mission, Vision, and Values of Saint Joseph Mercy Health System. Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.
OTHER FUNCTIONS AND RESPONSIBILITIES
Performs other duties as assigned.
REQUIRED EDUCATION, EXPERIENCE AND CERTIFICATION/LICENSURE
Requires high school diploma or equivalent.
CHAA certification from National Associate Healthcare Access Management preferred.
One or two years related experience.
REQUIRED SKILLS AND ABILITIES
Demonstrated computerized system application experience. Critical thinking and problem-solving skills. Analytical ability to affective and efficiently resolve registration, insurance and claims processing issues. Demonstrated knowledge of revenue cycle processes and terminology. Interpersonal skills to effectively communicate with patients, team members, clinical colleagues, medical staff, third party providers, and external agencies and contacts. Exceptional customer service skills and positive personality attributes. Patience in dealing with ordinary, arduous or emotional patients. Use of telephones.
Employees of St. Joseph Mercy Health System enjoy…
Full benefits package including Medical, Dental, Vision, PTO, Life Insurance and Disability
Retirement savings plan with employer contribution
Opportunity for growth and advancement throughout SJMHS and Trinity Health
Visit www.stjoeshealth.org/careers to learn more about the benefits, culture and career development opportunities available to you at Saint Joseph Mercy Health System.
Trinity Health's Commitment to Diversity and Inclusion
Trinity Health employs about 133,000 colleagues at dozens of hospitals and hundreds of health centers in 22 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
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Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 94 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities, and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually.
Based in Livonia, Mich., and with annual operating revenues of $17.6 billion and assets of $24.7 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity Health employs about 133,000 colleagues, including 7,800 employed physicians and clinicians.
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