PreArrival Associate - Goshen Radiology

Job Summary:

Responsible for facilitating patient access for services at the hospital by accurately and efficiently verifying patient insurance eligibility and obtaining any appropriate pre-certifications or medical necessity prior to the patient receiving scheduled services and then completing the pre-registration for the patient visit. This position is responsible for communicating to the Financial Clearance Associate any patients that will be presenting without insurance for further assistance or has any applicable copayment obligations that need to be presented to the patient prior to the day of service.

This position is responsible for providing excellent customer service when communicating with physician offices, other departments and/or patients while also protecting the privacy of the patient’s health information.

Primary

Job Responsibilities:

Obtains patient personal information and pertinent insurance information to accurately verify insurance eligibility, pre-certification information, financial obligations and medical necessity prior to creating the patient pre-registration for scheduled services. This includes utilizing appropriate strategies ie phone calls and online databases to verify the insurance coverage and to obtain benefit information such as deductible and copayment amounts.

Collaborates with the physician offices to obtain any pre-certification information prior to the day of service and documents this information in patient pre-registration record. This includes obtaining an additional diagnosis when a test does not meet medical necessity.

Communicates with the Financial Clearance Associate regarding any patients that have financial obligations due prior to the day of service and any patients that need financial counseling so that arrangements for payment can be made prior to the day of service.

Identifies when a physician is not in the registration physician dictionary and forwards that physician information to HIM to be added accordingly.

Coordinates the pre-registrations for the day of service for the patient access staff.

Accommodates the scheduling staffs when there are add-on or walk-in patients to determine insurance eligibility and determine at that time if any tests need pre-certification prior to the patient having the service.

Performs quality improvements to records as indicated by the quality improvement tool (RQi) in a timely and efficient manner.

Performs other miscellaneous assignments and/or duties as related to the position.

Education Requirements and Other Requirements:

Education Level: High school diploma or equivalent.

Prior Patient Access experience is required.

Prior Customer Service experience is required.

Experience Requirements:

Typing skills of 40-50 wpm Medical Terminology course or background preferred

Excellent communication and customer service skills needed

Computer and organizational skills.
1-2 years of registration experience with a detailed knowledge of insurance companies required.

Collection experience a plus.