Patient Coverage Rep

• Receives incoming calls from patients as well as business office team members to perform coverage updates. Updates information in the Electronic Health Record(s) (EHR) to ensure coverage is verified and accurate. Ensures appropriate steps are taken to initiate claims on affected transactions.
• Performs updates based on Visit Filing Order changes daily, ensuring claims are sent to the correct primary and/or secondary payor.
• Reviews electronic eligibility transactions returned for patients with upcoming services, as well as for services that have already been billed to the patient, performing the necessary updates to coverage as needed to ensure accuracy of coverage information.
• Sends and receives Customer Relationship Management requests (CRM) to communicate with other team members in the business office regarding patient-initiated insurance concerns.
• Follows up on patient-initiated insurance changes through the EHR Patient Portal and makes updates as necessary.
• Performs guarantor account updates based on patient-initiated requests, ensuring the appropriate guarantor type is being used based on billing requirements.
• Updates hospital account records (HARs) and visits to ensure Smart Chart identified data discrepancies are corrected.
• Works other EHR workqueues related to patient demographic, guarantor, and coverage information as needed.

Licensure, Registration, and/or Certification Required:

• None Required.

Education Required:

• High School Graduate.

Experience Required:

• Typically requires 2 years of experience in health care, with focus on registration, insurance, and billing.

Knowledge, Skills & Abilities Required:

• Knowledge and understanding of Revenue Cycle-specific insurance and billing procedures preferred.
• Previous data entry experience and demonstrated proficiency with emphasis on speed with accuracy.
• Good organizational ability as well as solid written and verbal communication skills.
• A basic understanding of EHRs, with the ability to gain deeper knowledge.
• Knowledge of Medicare, Medicaid and third-party payors.
• Knowledge of medical terminology.

Physical Requirements and Working Conditions:

• Must be able to sit most of the workday.
• Must be able to lift up to 10 lbs. occasionally.
• Operates all equipment necessary to perform the job.
• Exposed to a normal office or home office environment.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.