Miriam E. Wilson

This job completes one or more of the following processes (scheduling, pre-registration, financial clearance, authorization and referral validation and pre-serviceability estimations and collections) within Patient Access and creates the first impression of AHN's services to patients and families and other external customers. Articulates information in a manner that patients, guarantors and family members understand so they know what to expect and understand their financial responsibilities. Assumes clinical and financial risk of the organization when collecting and documenting information on behalf of the patient.

ESSENTIAL RESPONSIBILITIES:

• Gathers, prepares and sends billing for consults and testing at non-Epic facilities
• Responds to CRM requests for appointments
• Balances and closes cash drawer in Epic
• Prepares deposit slip and/or deposits money into bank and confirms deposit in Epic deposit tool
• Completes preregistration functions such as validating patient demographic information, identifying and verifying medical benefits and insurance information
• Collects copays and prior balances and posts payment transactions. Does not calculate estimates
• Obtains authorizations for office visit, testing and procedures
• Checks patient in/out
• Registers patient for billing not captured through Epic and organizes manual billing and sends to billers
• Scans documents into EPIC and prepares chart for office visits
• Proactively schedules and follows up with testing and manages follow up report
• Answers the phone, takes messages and forwards calls and calls patient to relay information.
• Works charge review and claim edit workqueues
• Proactively manages wait list
• Schedules procedures with patient and hospital and advocates MY CHART sign up
• Collects, sorts, distributes and prepares incoming and outgoing mail and provides information about services, physicians and facilities
• Communicates with physicians and midlevel providers regarding schedule and patient issues (no shows)
• Orders supplies to maintain inventory
• Support Medical Record request
• Proactively identify and report office issues to supervisor
• Performs other duties as assigned

• Performs advanced customer service activities and initiatives for a broad range of products, services and problem resolution that occurs across multiple channels for our customers
• Delivers CARES model to customers and service partners
• Receives, investigates and responds to customer inquiries regarding complex products, services and issues via all channels through which customers are served
• Resolves customer service inquiries and issues
• Recommends appropriate solutions
• Resolves more complex or reoccurring issues
• May interact with higher levels within the customer organization
• Maintains high levels of customer satisfaction consistent with PNC's core values
• Demonstrates commitment to quality through customer and service partner interactions
• Serves as a coach or mentor and may serve as a trainer to the customer service team
• Documents customer interactions and completes service requests to minimize customer effort or additional action.

• Responsible for one or more of the following activities: checks and verifies records, prepares invoices and vouchers, types, files, posts ledger and general journal entries and/or balances accounts payable and accounts receivable records
• Uses office automated systems to input data, generate reports, conduct specialized research projects and respond to inquiries
• May reconcile accounts
• May be responsible for a complete and systematic set of transactions in a specific phase of accounting

• The primary responsibilities of Medical Insurance Verification Representatives are to verify insurance coverage for potential new patients and re-verify insurance coverage for existing patients in order to process patient prescription needs successfully and demonstrate excellent customer service to patients, healthcare professionals and insurance carriers.

• Resolves product or service problems by clarifying the customer's complaint; determining the cause of the problem; selecting and explaining the best solution to solve the problem; expediting correction or adjustment; following up to ensure resolution
• Maintains financial accounts by processing customer adjustments
• Recommends potential products or services to management by collecting customer information and analyzing customer needs
• Prepares product or service reports by collecting and analyzing customer information
• Contributes to team effort by accomplishing related results as needed

• Conducting a detailed benefit and eligibility verification of insurance benefits for plan participants, including identifying the different plan and therapy requirements for processing their referrals, and validating the demographic and reimbursement information on all specialty customers in a database prior to the initiation of therapy
• Processing POS/Retail billings, relating financial obligations to the participant, and informing internal parties when a new customer is brought on for service
• Organization regarding contract and physician issues
• Responsible for understand and communicate medical information, identify potential issues, collect and document/publish data, establish facts, draw conclusions, and solve problems is essential.

• Responsible for supporting assigned Claim Managers by reaching out to providers by following- up on missing claim reports
• Also handle incoming claims (via email, fax, and standard mail) input information into company database .Request, follow-up and deliver mail to assign Claim Managers
• Handle inbound /outbound calls from the providers
• Pay Invoices for Medical Records.