Preadmission Review Assistant

Company: Mount Auburn Hospital
Location: Cambridge
Posted on: November 18, 2020

Job Description:

Preadmission Review Assistant

Mount Auburn Hospital - Cambridge, MA

Description:

Principal Duties and Responsibilities

1. Screens, verifies, and precertifies third-party insurance coverage on inpatient and selected outpatient accounts. Identifies copayment and deductibles, explains self pay responsibilities to patients and their families. Screens and explains free care possibilities and helps patients complete forms, as necessary.

a. Receives and reviews booking sheets and schedules and ensures that all appropriate demographic and insurance information is captured. Notifies physician and/or specialty physician offices to resolve problems.

b. Verifies insurance coverage and precertifies all required cases in a timely and accurate manner. Identifies self-pay responsibilities, copayment, deductible and coinsurance, discusses with patients, and enters information on financial screen in the computer system.

c. Reviews previous days admission/observation activity, in the computer, for completeness and accuracy and makes final edits as necessary. Provides the necessary follow-up with physicians, nursing units, patients, etc., to insure account is ready for billing. Provides necessary comments on accounts in ADM and BAR modules.

d. Understands and follows contract related information, regulatory information and hospital credit and collection policy.

2. Provides an assortment of functions related to self-pay or free care accounts.

a. Estimates hospital charges for elective or urgent self-pay accounts, and arranges for co-payments, deductible and deposits to be collected. Comment on account any payment received in ADM and BAR modules.

b. Reviews free care guidelines with patients, and refers patients to the Financial Counselors office or Social Services, as appropriate.

c. Involves the manager in problem cases, in a timely manner, providing thorough and specific information.

d. Defers cases with the permission of the manager and the admitting primary care and/or specialty physician as necessary.

3. Answers all internal and external telephone calls to Preadmission Review. Acts in a manner that fosters exceptional interpersonal relations, and represents the hospital in a positive manner while providing information to callers.

a. Answers a variety of financial-related inquiries in a professional manner, identifying oneself and the department at the start of each call.

b. Utilizes the utmost discretion when releasing any information by telephone. Seeks advice of management when unsure.

c. Receives and distributes messages or transfers calls as appropriate.

d. Provides specific follow-up to all calls or OA messages 100% of the time.

4. Maintains an updated knowledge of specific preadmission and insurance requirements. Keeps abreast of hospital/departmental policies and procedures.

a. Reads and understands all insurance updates and requirements, and incorporates changes into workflow. Utilize eligibility devices supplied by insurers and use of the internet to verify eligibility and referrals.

b. Acts as a resource to a variety of internal and external clients.

c. Responds well to constructive criticism and attempts to make changes based on input.

d. Maintains a working knowledge of all preadmission review functions by being cross-trained.

e. Contributes constructive ideas to improve department services.

5. Provides assistance with the orientation and training of new staff.

6. Assists in the care and maintenance of departmental equipment and supplies, and notifies manager of any equipment malfunctions or unsafe working conditions. a. Maintains a safe and secure work environment 100% of the time.

7. Enhances professional growth and development by attending hospital continuing education programs, listed under "Development Objectives." Attends hospital inservices as required.

Requirements:

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED

1. High school diploma, or equivalent, with two years of experience in a hospital financial setting required, with a thorough knowledge of preadmission review, credit and collection, third-party billing requirements, and free care regulations. Previous experience in verification for radiology procedures preferred. Typing skills to utilize computer systems and equipment.

2. Strong interpersonal, written, and verbal communication skills to deal professionally, courteously, and tactfully with patients, patients' families, and all levels of hospital staff, as well as a variety of outside business contacts.

3. Strong analytical ability to review and resolve problems successfully.

4. Demonstrated ability to work independently, and pay close attention to detail, for a high level of accuracy nearly 100% of the time.

Keywords: Mount Auburn Hospital, Cambridge , Preadmission Review Assistant, Other , Cambridge, Massachusetts