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The Authorization and Financial Counselor is generally assigned a primary work area within the Pre-Access Unit, but may rotate or be assigned to any area or site within the Patient Access Department as outlined in departmental expectations. In general, the Authorization Counselor is responsible for all spectrums of financially securing the insurance and authorization data for services financially cleared through the Patient Access Department. The responsibilities include obtaining: 1) authorization from third party payers (and/or their designated review organizations), 2) verifying insurance eligibility and benefits, and 3) verifying basic demographic and clinical information relevant to the appropriate check-in or bed placement of the patient. The financial clearance process also includes calculation and discussion of liability estimates with the patient or guarantor on an as needed basis.
Reports to the Pre-Access Supervisor.
DUTIES & ESSENTIAL JOB FUNCTIONS
1. Obtain authorizations for hospital services by working with physician’s office staff, the applicable Medical Center ancillary department, and/or review organization(s) as required. Enters authorization data in the registration and insurance verification screens.
2. Interviews patients over the phone or in person to collect patient demographic information and financial/insurance data.
3. Verifies insurance eligibility and benefits and enters data in the registration and insurance verification screens.
4. Collects clinical data from Apex clinical records, reservation forms, procedure schedules, special procedures schedules, etc. and sets up the appropriate account specific to the patient in the APeX electronic medical records system. Provide clinical information to payers as needed.
5. Registers patients for specialized outpatient services such as Observation (OBS) status, Outpatient Ambulatory Surgery, Special procedures or in the absence of the Outpatient Registrar for general services.
6. Financially clear hospital services by securing the necessary pre-authorization and/or calculating and discussing liability estimates with patients (or patient guarantors). Secure any documentation as necessary.
7. Answers patients’ questions regarding the registration and/or admitting process. Refers any clinical queries to the nursing or physician staff.
8. Resolve, as necessary, any complex financial arrangements or authorization requirements to the satisfaction of the Medical Center, physicians, and patient who may not be able to meet payment requirements. Refers only the most complex cases to a Patient Access supervisor for additional instructions and/or training for future resolution.
9. Meets the productivity and accuracy standards of the overall Admitting Department and units within the department.
10. Actively participates in staff meetings to assimilate changes in procedures, new program requirements or training reviews of existing procedures. Updates and maintains own file of procedures, notices of changes, etc. so that related knowledge and skills are always current.
11. Works in all areas of the unit or department as assigned.
12. Willing to work flexible hours. This includes holidays, weekends, overtime and other shifts as assigned.
13. Comply with Client Service Excellence and Patient Access department standards in interactions with patients, families, visitors and other staff.
14. Maintain proficiency and comply with all applicable infection control, health and safety policies and procedures as implemented by the department and/or work unit and the Medical Center.
15. Functions as a resource to other employees in the department.
16. Performs other duties as assigned by the Supervisor that include, but are not limited to: gathering data, maintaining statistical information, assisting with special projects.
17. Performs other duties as required.
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