Principle Accountabilities: % of Time Spent

1. Acts a patient liaison upon arrival to initiate patient flow and operations necessary to comply with managed care contracts and CMS regulations. Conducts face to face interview with patient to achieve successful clinical outcome and maintain charge integrity in clinically driven revenue cycle. Processes patient accounts in accordance with the departmental and institutional policies and procedures. Responsible for accurate registration of patient demographics and insurance and assures the validity of incoming data, corrects information as needed, and processes the registration including explaining and obtaining the patients signature on the Consent for Admission/Treatment, Release of Information/Assignment of Benefits and Financial Responsibility, and completing Medicare Secondary Payer (MSP) questionnaire. Collects proper consent for Missouri Health Connection to share PHI data. Assess and interpret Medical Necessity guidelines with providers to prevent denials and to comply with CMS regulations to formally notify patient via the appropriate format of their rights and limitations. Documents actions taken, answers inquiries involving patient registrations and researches problems to assure payment. Scans documents to the patient’s medical record via Cerner Imaging Functions. Verifies insurance eligibility and benefits to notify patients of expected financial responsibility and collect at the time of service. Provides financial counseling concerning payment options with patients and financial assistance. Reviews provider orders for accuracy and completeness and follows up with physician offices as needed. (60%)
2. Assures integrity of critical system data elements. Completes assignments in the prescribed time periods with efficiency and attention to detail. Answers patient and/or third-party inquiries of patient account, insurance eligibility and coverage questions, and/or institution or department policies or procedures. Adheres to Patient Access and St. Luke's Hospital's policies, hospital/physician billing practices, and third-party requirements and HIPAA regulations and obtains patient signatures on the Patient Representative, Motor Vehicle Accident, and Out of Network form. Teaches new employees and other staff members procedures. Works efficiently with other staff members to accomplish work and departmental projects. (25%)
3. Provides information and assistance to physicians regarding billing and pre-certification procedures. Works to resolve patient complaints and workflow issues before escalating to manager. (5%)
4. Performs other duties as assigned. (5%)

Total: 100%

Knowledge, Skills & Abilities

• Computer literate, with keyboard skill of 35-40 words per minute.
• Knowledge of medical terminology; medical terminology certificate helpful.
• Knowledge of CPT and ICD-10 coding.
• Ability to read and interpret physician notes, diagnosis and other clinical documentation.
• Effectively communicate patient assessments which include complications, conditions, diseases, diagnosis, previous treatment and severity of illness to clinical staff to ensure successful patient outcomes.
• Must possess excellent communication and customer service skills:
  • Active Listening-Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
  • Reading Comprehension-Understanding written sentences and paragraphs in work related documents.
  • Time Management-Managing one's own time and the time of others.
  • Speaking-Talking to others to convey information effectively.
  • Writing-Communicating effectively in writing as appropriate for the needs of the audience.
  • Active Learning-Understanding the implications of new information for both current and future problem-solving and decision-making.
  • Critical Thinking-Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
  • Social Perceptiveness-Being aware of others' reactions and understanding why they react as they do.
  • Judgment and Decision Making-Considering the relative costs and benefits of potential actions to choose the most appropriate one.
  • Service Orientation-Actively looking for ways to help people.
  • Pleasant speaking voice and demeanor.
• Neat, professional appearance.
• Must be self-motivated and able to work with others as part of a team.
• Ability to perform in a highly stressful situation.
• Ability to multitask.
• Ability to focus and maintain direction in the tasks at hand under pressure.
• Ability to establish effective working relationships with patients, physicians, insurance representatives and other medical support staff.

PHYSICAL DEMANDS: While performing the duties of this job, the employee is regularly required to sit. The employee is occasionally required to stand, walk, reach with hands and arms, stoop, and bend; and may require lifting of paper weighing up to 20 pounds. The position requires manual dexterity to operate computer keyboard, calculator, telephone, and other office equipment as necessary. Position requires continuous viewing and typing on computers and use of the telephone. Vision and hearing must be within normal range. MENTAL / EMOTIONAL DEMANDS: Mental activities necessary for this position include concentration, organization, multi-tasking, problem solving, stress control, dependability, and both verbal and written communication skills. This position involves frequent contact with staff and patients. Work may be stressful and busy at times. Contact may involve dealing with angry or upset people. Interaction with others is constant and interruptive. Position requires maintaining a high degree of confidentiality. WORK ENVIRONMENT: Work is performed in an office setting, well-lighted and ventilated, with adequate space.

Associate Degree or equivalent work experience required