Patient Access Representative & Insurance Specialist ( Women's Pelvic & Reconstructive Center)

We are a group of providers united by our clinically integrated, high-performance network and shared belief that physician autonomy is key to improving healthcare. As a physician-led medical group, we provide the tools, talent, and technology that enable you to improve patient care and your practice’s economic outcomes. We remove administrative work to help you transition to and thrive in value-based care so you can focus on patients, not paperwork and policy.

Overview of the Role:
The Patient Access Representative - Insurance Specialist (PARIS) has responsibilities across various business units of Women’s Pelvic Restorative Center as assigned by Management. Duties will generally conform with the below descriptions and fall into the areas of patient benefits determination and verification and revenue cycle management responsibilities. Duties will vary somewhat with each specific assignment and will be outlined prior to assignment. As of the date of this job description, the below are the outlines of some specific current and potential responsibilities.

Ancillary Job Duties:
The Patient Access Representative is responsible for all communications with the patients of Women’s Pelvic Restorative Center regarding their insurance and/or patient account, as well as, all communications with third party payers regarding benefits and/or payment of services. Duties include but may not be limited to:

● Obtain prior authorization and insurance benefits and must be completed three days in advance of appointments. Prior authorizations must be submitted to insurance for approval within 2 business days of receipt request from staff.
● Enter or scan all actions related to the patient's account into an electronic medical record including the prior authorization forms submitted to insurance companies when they are faxed for authorization.
● Obtain physician referral prior to treatment.
● Review upcoming appointments 30 days before scheduled services to obtain benefits verifications and referrals for treatment.
● Collect deposits, deductibles and/or co-pays from the responsible party. Work with patients to make financial arrangements.
● Respond to patient requests regarding information on their account. Explain financial policy and procedures as needed.
● Respond promptly to payer (insurance company, employer, etc.) calls and correspondence related to patient services and claims.
● Input benefits and prior authorization as well as insurance information for claims to ensure prompt and accurate billing. Work to resolve coding or billing errors in order to effect accurate reimbursements and minimize patient liability.
● Complete all necessary forms and medical documentation, as necessary, for copay programs available through the drug companies. Submit required forms and documentation for prompt payment.
● Coordinate with other staff to seek patient account resolutions.
● Follow up on unpaid and underpaid claims to effect complete reimbursement by the year/patient. Coordinate with billing/collections team to resubmit or correct and submit claims or submit appeals, as required.
● Audit all patient account transactions for accuracy and resolve any outstanding issues. Identify and correct billing errors.
● Communicate with manager, clinical staff and physicians regarding outstanding issues related to patient accounts.
● Use approved collection correspondence and/or calls to patients to effect collection of patient responsibility.
● Audit all patient credit balance accounts for resolution.
● Make recommendations to the manager concerning accounts to be passed to third-party collection or to be adjusted as uncollectible.
● Audit all patient account transactions for accuracy and resolve any outstanding issues.
● Identify and correct billing errors.
● Check daily the payments posted by Athena for accuracy.
● Contact patients after authorizations are obtained to explain benefits and coordinate payments for to the first appointment.
● As needed, notify manager when office supplies are needed and scan packaging slips to appropriate departments.
● Participate in educational and developmental activities.
● Attend meetings as requested.
● Perform other duties as directed by the supervisor.

Job Duties
The Patient Access Representative - Insurance Specialist may be assigned special projects designed to help care centers with specific issues related to claims production and/or collections, benefits verification, staff education or other revenue cycle management related issues. The PARIS will work closely with and under the direction of the Women’s Pelvic Restorative Center Director of Operations on the scope and details of such assignments.

● At least five years medical collections experience.
● At least three years working knowledge of CPT and ICD-10 coding standards.
● Comprehensive knowledge of clinical registration, patient accounting, billing,
   reimbursement and third party payer/managed health care procedures and practices.
● Knowledge of clinical departments and operational relationships.
● Knowledge of and ability to use CPT and ICD-10 coding standards.
● Understands advanced level of medical office terminology.
● Skilled in analyzing accounting, billing, coding, and third party payer reports.
● Ability to perform mathematical computations and compute ratios and percentages.
● Skilled in defining problems, collecting data, interpreting billing information.
● Skilled in using medical software computer applications.
● Ability to organize work for the highest level of efficiency.
● Ability to communicate clearly and be self motivated.
● Ability to develop and maintain positive, effective relationships with patients and staff.

Education/Certificate/License
● High School Diploma or GED; some college preferred

All your information will be kept confidential according to EEO guidelines.

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Technical Requirements (for remote workers only, not applicable for onsite/in office work):

In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like https://www.speedtest.net/. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.

Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. Privia is a better company when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age, color, national origin, physical or mental (dis)ability, race, religion, gender, sex, gender identity and/or expression, marital status, veteran status, or any other characteristic protected by federal, state or local law.