Job Title

Admissions & Collections Clerk - Insurance Verification / QA Team - Moreno Valley Under general supervision, incumbents will verify eligibility for insurance, authorizations, and referrals; communicate with admitting and registration, clinics, ER, MISP, operating room, and PSC staff as needed; specialize in clerical work for checking"‘in, admitting, pre"‘registering, and scheduling patients for hospitalization or clinic visits; evaluate and determine financial liability for services, establish payment sources, and arrange payment plans consistent with patient ability to pay. Additional duties as required. This is a high"‘paced, high"‘volume position. The department works closely with admitting/registration, clinics, ER, MISP, operating room, and PSCs to obtain insurance coverage and verify authorizations/referrals for high"‘dollar procedures such as surgeries, infusions, and GI visits. The department is divided into micro"‘departments handling inpatient admissions, elective high"‘dollar procedures, ER review, billing edits, and returned mail. This position telecommutes; the incumbent is expected to drive only for meetings, special events, or trainings. Work Schedule: 5/40 - Monday through Friday, 8:00"¯am - 4:30"¯pm. Professional Experience Preferred Bilingual Authorizations and referrals EPIC IEHP, Medi"‘Cal, managed Medi"‘Cals, and Medicare GI procedures Infusions Inpatient admissions and surgeries Responsibilities Review patient personal data to evaluate eligibility for medical assistance programs using formal guidelines. Examine insurance forms and cards to ensure completeness and accuracy for billing and payment. Evaluate potential assistance eligibility and refer patients to Medi"‘Cal and MISP as appropriate. Contact patient's insurance carrier to obtain authorization for treatment and verify eligibility and coverage. Assist patients with scheduling hospital or clinic appointments in person or over the phone. Pre"‘register scheduled services during the scheduling process or any time prior to receiving services as directed by supervisor or manager. Receive and record payments for medical treatment from patients. Record payment information on patient payment receipt and log this information on the appropriate forms. Complete patient medical information or MISP Share of Cost forms; attach cash payment receipt to ensure reimbursement from medical assistance programs. Refer patients with problem accounts to Patient Accounts for review of account status. Receive required information from patients and complete medical forms to ensure accuracy of patient data. Collect and prepare receipt for monies. Register patients for medical services such as emergency treatment and non"‘emergency walk"‘in treatment. Serve as a resource person for patient registration in RUHS clinics. Assist in conducting outpatient registration audits and participate in quality assurance initiatives. Reconcile daily charge sheets of patient visits to ensure that charges for healthcare services rendered are captured in a timely manner. Experience Options OPTION I: Two years of clerical experience, including three months performing admissions, collections or billing functions in a healthcare setting; completion of 18 semester or 27 quarter units from an accredited college or university in secretarial sciences, office practices, business education, or a closely related field may substitute for one year of the non"‘specialized experience. OPTION II: Two years of clerical experience, including three months performing admissions, collections or billing functions in a healthcare setting; completion of 360 hours of training from a recognized occupational training program in secretarial sciences, business education or a closely related field may substitute for one year of the non"‘specialized experience. OPTION III: Two years of clerical experience, including three months performing admissions, collections or billing functions in a healthcare setting; six months of clerical experience in a medical setting may substitute for one year of the non"‘specialized experience. Knowledge Modern office procedures, including the preparation of reports and correspondence and filing; the operation of standard office equipment; and medical terminology. Ability Perform complete registration cycle, including collection of monies; interview to obtain personal, family and financial information; gather, record and evaluate data in the admission of hospital patients and handling of patient accounts; maintain accurate records; apply the rules and regulations pertaining to patient admission, private and public medical insurance, billing procedures, credit authorizations, and payment agreements; and work with very ill, injured and emotionally distressed people. Physical Requirements Repetitive data entry in EPIC; requires repetitive motion. #J-18808-Ljbffr