This position receives, coordinates and implements the initial patient experience by providing critical functions essential to ensuring proper billing and reimbursement, patient satisfaction as well as efficient and accurate handling of the referral process. This position is responsible for all pre service functions; which includes receiving the referral request via EMR system, appointment scheduling, insurance prior authorization and notification, validating medical orders, procedure protocol clearance, patient pre-registration by telephone, insurance eligibility, verification of benefits and financial clearance (patient responsibility collections prior to service) of scheduled outpatient and all inpatient accounts for SMC and PMC. This includes but is not limited to government, commercial, managed care, grant & philanthropic funds and patient responsibility accounts. This position serves the critical role of maintaining an effective and comprehensive relationship with external and internal physician customers. The CRC Representative serves as the contact person for insurance case managers. Must be able to effectively work with Case Management, Medical Group of the Carolinas, Business Services and Patient Access Services. This includes services lines for 42 Imaging modalities & locations, Surgery, Rehabilitation, OB/GYN, Anesthesia, Language, Food & Nutrition, Laboratory and all Cardiac Services. This position reports directly to the Manager of the Centralized Referral Center and maintains a close and effective working relationship with other associates and leadership roles to ensure efficient collaboration of pre service and patient flow operations. This position is responsible for production and adherence to measurable strategic departmental and system goals in relation to the expected process of patient flow, prevention of denials and point of service cash collection performance measures.
Required: High School Diploma or GED Preferred: Associate's Degree
Required: Entry Level (0-3 years) Preferred Mid-Level (4-7 years)
CERTIFICATIONS, LICENSES and/or REGISTRATIONS
Required: Preferred: -Currently certified as CHAA or CMIS, otherwise certification eligible.
* Must exhibit initiative and independence that is required in assisting Manager in properly controlling workflow in the department.
* Must demonstrate discretion in handling confidential information and work professionally with patients, families, physicians and other departments.
* Must have the following work experience requirements:
- Minimum of 2 years of experiences in a medical office or hospital setting
- Prior authorization and notification experience
- Medical insurance experience (verification, benefits, exclusions, collections)
- Customer services and phone etiquette skills
- Minimum of 40 wpm for typing
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