Sacramento, California
Insurance Eligibility and Collection Representative Job Opening in Sacramento, California - POSITION : Insurance Eligibility and Collection Representative
DEPARTMENT : Operations/Patient Services
REPORTS TO : Patient Financial Services Manager
PHI LEVEL: 3 (Editing Access-Modify/Edit)
FTE : 100% Full-Time (40 hours weekly)
SALARY: Hourly, Non-Exempt
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PLEASE USE THE FOLLOWING LINK TO APPLY FOR POSITION:
?ApplyToJob=117465800
Position Summary:
Under the direct supervision of the Patient Financial Services Manager the Insurance Eligibility and Collection Representative is responsible for the verification of insurance eligibility for patients receiving Medical, Behavioral Health, and Optometry services within the health center. This includes collection of basic necessary registration data on new insurance programs and updating the patient demographics as it relates to the payer source for patient encounters. As part of the clerical administration process, s/he will determine eligibility for public insurance programs, and obtain verification of private insurance. Position also includes responsibility of communicating to registration staff any outstanding patient balances needing collection during the check-in process of the patients next clinical appointment.
Duties & Responsibilities:
Verify that sufficient information is available for accurate verification and eligibility. This step may require direct contact with patients
Utilize the NextGen RTS system and/or individual payer websites to obtain eligibility, benefits and/or pre-authorization information
Enter the patient insurance information into patient NextGen Practice Management system ensuring the selection is the appropriate payer and associated financial class
Ensure specialty authorizations have not expired
Be familiar with individual payer guidelines and the process of collecting over the counter
Knowledge of payer contracts including Medicare, Medicaid and other government contracts and guidelines
The Insurance Eligibility and Collection Representative will document the eligibility findings in the patient record and will contact the patient with either outstanding balance amounts due on or before the date of service as applicable.
Refer patients to on-site Certified Enrollment Counselors for enrollment and re-enrollment of Medicaid, Affordable Care Act (ACA), and other state and federal programs.
Confirm SNAHC is the assigned Primary Care Physician (PCP) with patient insurance plans
Appropriately notifies patients of any eligibility conflicts.
Conduct reminder calls the day prior to appointments once insurance eligibility has been confirmed.
Responsible for ensuring all the information entered into the Electronic Health Record (EHR) is accurate and complete. This includes reviewing and verifying any paper documents to make sure that all forms are completed, identified, signed and corrected.
Responsible for EHR required data entry as it relates to insurance eligibility prior to any services by any provider, must be able to complete this task efficiently and effectively.
Responsible for maintenance and upkeep of the electronic records database. Must be keenly aware of EHR software usage requirements, this requires a high level of problem solving skills and abilities.
Responsible for the security of electronic database, and for reviewing and submitting electronic data that may give insight into patterns of disease and treatment outcomes when requested.
Assists patients with health insurance information such as Medi-Cal, Medicare, and GMC (Geographic Managed Care) programs. Refers to Care Coordinator when necessary.
Verifies patients have updated their patient consents and demographic information within the last 12 months, and schedules annual update when necessary with Member Services.
Completes daily corrections as requested by department manager.
Maintains the upmost confidentiality and adheres to Health Information Portability and Accountability Act (HIPAA) laws in handling all healthcare related patient information.
Abide by industry best practices (e.g. proper PPE, ergonomic posture, etc.) to maintain a safe working environment; report safety issues or concerns to your supervisor or the Safety Officer immediately; review Safety and Health plans, understand, and ask questions regarding safe practices in work areas.
Any additional duties as requested by department directors and the Patient Financial Services Manager.
Minimum Qualifications:
Must have 2+ years of knowledge and experience working in a medical clinic front office setting with customer service as well as dealing with the public.
Expertise in all services provided by medical department
Expertise in medical insurance processing and familiarity with local Geographic Managed Care Plans (GMC).
Required experience with electronic health records software and appointment scheduling software (NextGen).
Excellent computer skills, preferably with Windows, including Microsoft Office Suite 2007.
Type at least 50 wpm
Ability to operate general office machines including, but not limited to, 10 key adding machine, copier/scanner, fax, voicemail, credit card machine, two-way radio, and IBM compatible P.C.'s
Excellent telephone and communication skills. Must be polite and helpful at all times. Must demonstrate superior professionalism when dealing with clients, staff, and vendors.
Must possess excellent organizational, writing and verbal skills.
Excellent grammar, punctuation, and spelling skills.
Ability to work independently, set priorities, and work well under pressure.
Compliance with all state and federal laws and regulations, as they pertain to position including; HIPAA, sexual harassment, Scope of Practice, OSHA etc.
Knowledge and understanding of Native American culture desirable.
Understands and promotes the mission, vision, and values of the health center both in the work place and in the community.
Preference in hiring is given to qualified Native Americans in accordance with SNAHC policy. Applicants claiming Indian Preference are encouraged to submit verification of Indian certified by tribe of affiliation or other acceptable documentation of Indian heritage.
EQUAL OPPORTUNITY EMPLOYER: Within the scope of Indian Preference, all candidates will receive equal consideration without regard to race, color, age, gender, religion, sexual orientation, national origin, medical condition or physical or mental disability, genetic characteristic, pregnancy, marital status, veteran status, or other non-merit factors.
Age Discrimination in Employment Act (ADEA): Sacramento Native American Health Center, Inc. abides by the mandates of the ADEA (protecting individuals 40 years and older) and considers age a non-merit factor in all employment decisions and considerations.
Americans with Disabilities Act (ADA): Sacramento Native American Health Center, Inc. abides by the mandates of the ADA and considers disability a non-merit factor in all employment decisions and considerations. Furthermore, SNAHC will make any practical, feasible, and reasonable arrangements to accommodate qualified applicants and employees with disabilities.
Applicants and employees may request an accommodation of a physical or mental disability at any time in the application process or during employment
Note to Applicants: Please be advised that you may be asked to get a Department of Justice Fingerprinting clearance as a contingency for an offer of employment. Criminal clearances are obtained to protect the welfare and safety of clients receiving services at SNAHC.
Job Type: Full-time
Required education:
High school or equivalent
Required experience:
knowledge and experience working in a medical clinic front office setting with customer service as well as dealing with the public.: 2 years
Required language:
SPANISH
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