PATIENT ACCESS SERVICES REP I, SGMC FAMILY & SPORTS MEDICINE

Description

Location: SGMC FAMILY AND SPORTS MEDICINE
Department: SGMC FAMILY AND SPORTS MEDICINE
Schedule: Full Time, 8 HR Day Shift,

POSITION SUMMARY 

Responsible for obtaining necessary demographic and financial data through patient interviews, the centralized scheduling system and system queries to complete the pre-registration process. Requires verification of insurance benefits and accurate entry of patient demographic and financial data. Will be responsible for fulfilling managed care requirements and pre-certification needs. Will be accountable for accuracy of information entered and documentation provided. Will coordinate referral of account to appropriate PFS personnel, including Customer Service Representatives, Billers, and Patient Account Collectors. 

KNOWLEDGE, SKILLS & ABILITIES 

• Technical/system skills/knowledge: PC and Windows literacy required; prefer knowledge of, or experience with, HBOC Series 2000 ADT/PA, Florida Shared System, Medifax, Microsoft Office applications, and Dr. Chart. 
• Extensive knowledge of insurance/managed care, to include: Medicare; Medicaid (Georgia and Florida); Peach Care; Tricare (Standard, Extra and Prime);VA; Disability Adjudication Services; Vocational Rehabilitation; Children’s Medical Services; Cancer State Aid; Crime Victim’s Compensation Program; Knight’s Templar Eye Foundation; Managed Care (HMO, PPO, POS, Medicare HMO); COBRA; Worker’s Compensation; Georgia Indigent Care Trust Fund; Blue Cross (Georgia, Florida, out-of-state and FEP); and Institutional Billing. 
• Strong verbal communication skills. 
• Interacts with: patients; other departments; physician offices; other acute medical care providers; insurance companies; pre-certification companies; employers; intermediaries; utilization review companies; state regulatory agencies (GMCF, Medicaid); and attorneys. 
• Knowledge of, or coursework in, medical terminology. 
• Familiarity with CPT-4, HCPCS, ICD-9, and DRG coding. 
• Related regulatory and legal requirements: Medicare Secondary Payer Questionnaire; Advance Directives (living wills, healthcare surrogate); medical necessity checking requirements; ABNs; letters of non-coverage; coordination of benefits. 
• Reimbursement methodologies: percent-of charges; DRGs; discounted fee-for-service; fee schedule; cost-based; capitation; per diems. 
• Must have a thorough understanding and knowledge of patient type; financial class; insurance master; employer codes; clinic codes; physician coding; admission source codes; relationship codes; accommodation codes; special handling codes; medical service codes. 
• College degree or coursework preferred. CPAR preferred. 
• Must be able to organize workload in an efficient manner and type 40 wpm accurately. 
• Previous data entry, programming, office coordinator experience highly preferred. 
• Spanish bilingual highly desirable.

WORKING CONDITIONS - ADA INFORMATION

Modern, well-lighted, air-conditioned, general work area. Moderate noise level. Occasional overtime required. May be at risk for exposure to blood and body fluids. Ability to sit, stand or walk for moderate periods. Safe and efficient operation of office equipment including copier, fax, printers, computer, telephone, adding machine, Medifax, and credit card machine. Reading of printed materials, including physician orders. Listening and verbally responding to customers, staff, physicians and visitors. Moderately heavy lifting {0-25 lbs.}, reaching, stooping, pushing, pulling, bending, and twisting.