Fairview Health Services Patient Service Associate Non-Clinical in St. Paul, Minnesota
Works with the Patient Services Team to administer processing of all referrals including data entry into patient accounting system. Compiles necessary referral intake information in a timely manner to facilitate scheduling of assessment/reassessment visits. Verifies validates the initial ongoing insurance benefit information for home care coverage as well as determining the appropriate payer/billing sequence for home care services. Obtains authorization/referrals for all home care services as defined by the health insurance plans. Runs statistical reports.
Maintains knowledge of, and complies with, all relevant laws, regulations and policies, procedures and standards
Actively participates in creating and implementing improvements to achieve clinical, satisfaction and/or efficiency outcomes
Initiates prior authorization and completes insurance eligibility verifications for all incoming referrals, making direct contact with insurance entities for initial visit authorization. Obtains appropriate documentation and forms for current and subsequent authorization
Inputs authorizations into patient accounting system on an ongoing basis. Completes tracking and trending reports from the patient accounting system as requested by the department director
Coordinates with Clinical Patient Service Associate regarding referrals of patients whose payment source is questionable. Collects and reports referral information and data. Verifies initial payer information and validates payer information. Works with HMO's and commercial insurances to identify home care benefits
Obtains authorization from governmental/nongovernmental third party payers, validates Medicare information and correct billing for home care services. Completes monthly title 19 verification, and redirecting tasks that require professional clinical input
Enters and maintains clinician working schedules in patient scheduling system. Completes the scheduling process for professional and paraprofessional staff on an ongoing basis. Supports field staff requests to schedule interpreters and verify times for visits that require interpreter services. Assists with preparation of weekend work assignments for field clinicians
Logs and tracks information as requested and defined to monitor processes. Triages open visits while working with the Case Manager. Provides updated census, monthly team and on call schedules and staff listing. Assists with preparation of weekend work assignments for field clinicians
Maintains communication with all appropriate departments, insurance companies, patients, and patient families
Collaborates with patient accounting department in response to nongovernmental, third party payer denial/rejections as appropriate and in regard to billing issues with billing sequence set up
High school graduate or equivalent required
1 to 2 years post high school education/training in medical or business field preferred
1 to 2 years home care insurance/billing or managed care environment experience
Medical field/medical terminology background desired
Attention to Detail: Achieves thoroughness and accuracy when accomplishing a task
Computer Skills Advanced: Skilled in specialized computer software. Ability to use more advanced functions, formulas and other special elements of the specific program or application
Coordination: Integration of activities, structures, and responsibilities so that resources are used most effectively to meet objectives
Decision Making: Makes timely, informed decisions that take into account the facts, goals, constraints and risks
Interpersonal Communication: Skilled in developing effective rapport with customers, co-workers, or families, actively listening to develop a positive connection
Problem Solving: Identifies problems; determines accuracy and relevance of information; utilizes appropriate tools and staff resources along with sound judgment to generate and evaluate alternatives, and to make recommendations
Scheduling: Knowledgeable in assigning appropriate amount of resources to meet business need
At HealthEast, our patients are our neighbors and we are dedicated to their, and our, optimal health and well-being. We are guided by our faith-based heritage, a call to healing that respects the dignity and culture of every person. We empower our patients with user-friendly access to their health information, dependable service, and affordable, high-quality care.
We put new, more efficient models of care into practice, allowing our 7,500 employees and 850 physicians to focus on what’s important: providing compassionate health care that puts the patient and their needs first. With 14 clinics, home care, a medical transportation center, and four hospitals — Bethesda Hospital, St. John’s Hospital, St. Joseph’s Hospital, and Woodwinds Health Campus — we provide excellent family health and specialization, including primary, maternity, orthopaedics and post-acute care.
Job ID 2018-10149
Category Patient Care Support/Nursing Assistant
Contract Status NH
HealthEast is an Equal Opportunity Employer. HealthEast will not discriminate in public accommodation, or employment on the basis of race, color, creed, religion, national origin, sex, marital status, status with regard to public assistance, membership or activity in a local commission, disability, sexual orientation, gender identity or expression, age or genetic information.