Determine eligibility for third-party reimbursement. Process and monitor Medical Assistance/Medicaid applications for patients.

Determine eligibility for third-party reimbursement and maintain patient account tracking system to monitor accounts.

Under general direction, contact third-party payors to obtain insurance eligibility and benefit information, estimate and collect deposits, and counsel patients regarding insurance coverage and hospital billing procedures.

Verify eligibility and benefits for third-party payors for planned and emergency admissions; validate prior authorizations for admission; 

Estimate hospital charges, calculate anticipated reimbursement, and determine necessary deposits; 

Counsel patients regarding their third-party coverage, financial responsibility, billing procedures; 

Obtain detailed financial information, request deposits and make referrals to Medicaid Application Unit, Hill-Burton Program, and Hospitals Collection Department; 

Review patient account summaries of unbilled charges, billings, payments and collection activity; 

Obtain all claim forms, authorizations from third-party payors and signatures required for billing within department processing standards; 

Counsel patients regarding financial arrangements for special programs and experimental protocols; 

Review and monitor accounts for inpatients; initiate process billings; 

Obtain or validate prior authorization for admission; monitor length of stay and approved days; report to Utilization Management for concurrent review activities; 

Maintain and update billing requirement tracking system; Update and maintain demographic and financial information; enter this information on-line to the central ospital database; 

Compose various correspondence related to reimbursement and billing procedures; 

Assist patients in accessing hospital and community services by consulting and making referrals to social workers, patient care coordinators, nursing liaisons, and outside agencies; 

Perform related duties as required. 

There may be instances where individual positions must have additional licenses or certification. It is the employer’s responsibility to ensure the appropriate licenses/certifications are obtained for each position.

Two years of college-level courses.

OR 

Two years of experience in a health care business office, medical insurance office, social services agency, or customer service position in a financial institution.

OR 

Equivalent education/experience.