61st Street Service Corp

Patient Access Specialist

• Greets patients and answers telephone calls
• Schedules appointment requests
• Indicates special needs (e.g. special accommodation, interpreter, etc.)
• Communicates insurance participation, financial responsibility, and time of service policy to patient population
• Obtain patients insurance and demographic information and ensure all obtained information is registered in EPIC
• Performs real-time insurance verification and interprets responses
• Collects pre-registration information to address outstanding Epic work queue accounts
• Performs outbound calls to perform Epic referral scheduling
• Contribute to the team by providing support and back-up coverage as needed and directed by Supervisor and/or Manager
• General faxing, filing, and mail sorting
• Performs other related duties as assigned

Patient Access Specialist I

Customer Support

• Handle large volume of calls and perform work in a timely manner.
• Attempts to collect full payment from patient or guarantor in a professional and courteous manner.
• Establishes payment arrangements per guidelines.
• Documents terms in billing system.
• Applies of payments collected over the phone to each date of service.
• Handles customer inquiries, disputes and complaints.
• Escalates contentious complaints to supervisor or higher management.
• Obtains all insurance, demographic, guarantor information and updates patient profile as well as bill third party payers as appropriate.
• Clearly documents in system summary of work and follow up steps after each call.

Customer Service Specialist I

General

• Verifies insurance coverage via system tools, payer portals (Electronic Query (Real-Time-Eligibility [RTE]/Insurance Payer Portal/Phone).
• Upon verification of patient's insurance coverage, update changes in the billing system.
• Confirms providers participation status with patients insurance plan/network.
• Determines payer referral and authorization requirements for professional services.
• Contacts patient and PCP to secure payer required referral for planned services.
• Documents referral in practice management system.
• Research system notes to obtain missing or corrected insurance or demographic information.
• Initiates authorization and submits clinical documentation as requested by insurance companies.
• Manage faxes, emails, and phone calls in a timely manner.
• Responds to voicemails and emails within same business day of receipt.
• Serves as primary liaison between faculty practice/department, insurance companies and patient to verify eligibility and coordination of benefits and resolve any insurance complications.
• Performs other job duties as assigned.

Referrals Specialist I

Collections

• Attempt to collect full payment from patient or guarantor.
• Apply payments collected over the phone to each date of service.
• Establish payment arrangements and document terms in billing system.
• Handle customer inquiries, disputes and complaints.
• Escalate to supervisor or higher management as needed.
• Obtain insurance, demographic, guarantor information and update patient profile as well as bill third party payers as appropriate.
• Clearly document in system summary of work.
• Evaluate the patients ability to pay for services.
• Create payment arrangements via cash, check, credit card or payment plan as appropriate.
• Utilize Epic estimator tool to provide estimates and collect upfront payments, deductible and copays.
• Obtain insurance information, check eligibility for active coverage and update patient accounts accordingly.
• Determine coverage for planned clinical services and calculate patient expected out of pocket expenses.
• Answer and return phone calls and other general office tasks.
• Perform other job duties as required.

Self-Pay Collections Specialist II

Insurance

• Responsible for verifying patient insurance coverage, to ensure necessary procedures are covered by an individuals provider.
• Notify patient and help arrange alternative payment methods when insurance coverage does not cover services.
• Responsible for entering data in an accurate manner in order to update patient benefit information correctly in EMR and verify that existing information is accurate.
• Perform routine administrative and clerical tasks.
• Verify insurance coverage in a timely matter.
• Request payments from patients and guarantors where appropriate.
• Perform related duties as assigned.
• Complete insurance verification for more complex visit types (e.g. major surgery).
• Act as a point of escalation and monitor supervisory or secondary work queues.
• Work with complex insurance companies for verifications.

Insurance Verification Specialist II

Authorization Specialist

• Responsible for verifying insurance policy benefit information, and securing payer required authorizations.
• Obtains accurate and timely pre-authorizations for professional services prior to the patient's visit.
• Verifies insurance coverage via system tools, payer portals, etc. and updates changes in billing system.
• Confirms providers participation status with patients insurance plan/network.
• Determines payer referral and authorization requirements for professional services.
• Contacts patient and PCP to secure payer required referral for planned services.
• Documents referral in practice management system.
• Researches system notes to obtain missing or corrected insurance or demographic information.
• Reviews clinical documentation to ensure criteria for procedure meets insurance requirements.
• Initiates authorization and submits clinical documentation as requested by insurance companies.
• Follows through on pre-certifications until final approval is obtained.
• Communicates with surgical coordinators regarding authorizations status or denials.
• Submits appeals in the event of denial of prior authorizations or denial of payment following procedures.
• Serves as back-up to Authorization-Referrals Specialist III.

Authorization Specialist II

• Verifying patient insurance coverage
• Research accounts to determine correct insurance coverage
• Heavy interaction with insurance companies and patients
• Contact patient as appropriate to obtain proper insurance coverage
• Contact insurance company(s) as appropriate
• Verify insurance via system tools, payer portals
• Confirm effective and termination dates of patient insurance
• Update patient's insurance coverage and changes in billing system
• Resolve any issues with coverage and escalate complications to supervisor/manager
• Correct identification and selection of appropriate registered insurance
• Correct errors in various work queues to ensure correct claim filing or refiling of denied claims
• Notify servicing providers office personnel if registration is lacking critical information
• Perform other job duties as required.

Insurance Verification Specialist I

• Follow-up work on Self Pay account balances
• Handle inbound calls generated by auto-dialer to secure payment
• Establish payment arrangements and obtain updated patient information
• Collect full payment from patient or guarantor
• Apply payments collected over the phone to each date of service
• Handle customer inquiries, disputes and complaints
• Document terms in billing system
• Evaluate the patients ability to pay for services
• Utilize Epic estimator tool to provide estimates and collect upfront payments
• Determine coverage for planned clinical services and calculate patient expected out of pocket expenses
• Answer and return phone calls and other general office tasks
• Perform other job duties as required.