Nuvance Health has a network of convenient hospital and outpatient locations - Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York - plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology care, and two urgent care offices. Non-acute care is offered through various affiliates, including the Thompson House for rehabilitation and skilled nursing services, and the Home Care organizations.

Summary:

Utilizing a high degree of accuracy in obtaining and verifying pre-registration, eligibility determination, benefits verification, pre certification / authorization, notification, screening for financial counseling, referral coordination, outpatient medical necessity determination, and pre-service communication and collection of any required patient liabilities. Employee obtains and verifies insurance / payment source, seeks necessary referral / authorization and coverage extensions as required, and assists with identification / resolution of insurance issues all required demographic, financial, referral / authorization, clinical, and other registration data is collected, verified, and communicated appropriately. Perform insurance eligibility. Communicating with all HQMP Team, patient and office staff, exhibiting and utilizing a high level of customer service skills in all aspects of the job. Responsible for performing a wide variety of clerical duties for administrators and practice staff.

Responsibilities:

1. Performs routine pre-registration and financial clearance on appropriate patients accurately and timely and meets departmental productivity standards.
2. Ensures that proper insurance company, plan choice, prioritization and billing address are assigned in the system. Follows up with appropriate and necessary parties to obtain required data elements as outlined in the HQMP Pre-Visit Financial Clearance Policy and Procedure.
3. Collects, verifies, and records all necessary information for financial processing of patients. Interacts with third party payers telephonically or electronically through use of websites to perform financial processing of patients. Investigates patient insurance coverage and obtains authorizations from insurance companies when required.
4. Documents detailed benefit and eligibility information for physician offices, service sites and ancillary departments, as well as including but not limited to referrals / authorization information.
5. Advises patients and / or family members of payer specific financial obligations prior to the date of service and requests any patient liabilities (e.g. deductible or co-insurance) as appropriate. Accurately documents financial obligations of patients and amounts collected in the system, posts payments (where applicable) and ensures follows cash reconciliation procedures accordingly.
6. Coordinates with and acts as a concierge service to HQMP Billing department for financial assistance, as needed. Identifies situations where patients should speak with a Financial Counselor to discuss detailed payment inquires.
7. Identifies and discusses options or financial assistance programs with patients who fit the criteria of either service. Screens patients appropriately based on policies and procedures.
8. Self-manages daily processing workload and prioritizes patient accounts to accurately complete work in a timely, efficient manner to prevent service delays and payment issues.
9. Assists in maintaining an accurate electronic record of the patient type and ensuring proper payer authorization based on type of service.
10. Answers patient calls and schedule patient appointments for multiple sites. "Soft" transfers patients to appropriate office for any additional patient needs.
11. Confirm next day appointments, ensures all follow up calls are completed same-day, prepare and process correspondence.
12. Notifies HQMP Site Supervisors of scheduling discrepancies/requests outside of the schedule guidelines. Prepares patient documentation needed from hospitalist offices to accompany the scheduled appointment.
13. Maintain and Model REACH Values (Respect, Excellence, Accountability, Compassion, Honor)
14. Demonstrates regular, reliable and predictable attendance
15. Performs other duties as required

Other information:
Required: High School Diploma / GED or equivalent experience.

• Minimum of one (1) year in a customer service role.
• Prefer Call Center experience.
• Prefer Medical Office experience.
• Excellent oral and written communication skills.
• Prefer: Experience with electronic medical records, eClinical Works strongly preferred.
• Prefer: Bi-Lingual

Location: Taconic-1351 Route 55

Work Type: Full-Time

Standard Hours: 40.00

FTE: 1.000000

Work Schedule: Day 8

Work Shift: 9:30-6

Org Unit: 909

Department: HQMP Connect

Exempt: No

Grade: S2

EOE, including disability/vets.

We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business. If you believe you require such assistance to complete this form or to participate in an interview, please contact Human Resources at 203-739-7330 (for reasonable accommodation requests only). Please provide all information requested to assure that you are considered for current or future opportunities.

Salary Range: 15.3-25.65