St. Joseph Health Patient Access Representative- Full Time in Anaheim, California

Job Summary: The Patient Access Representative performs daily new referral patient benefits verification. Obtain all necessary authorization for all services being performed. Notification of financial responsibility to all patient’s / responsible party prior to services being rendered. Mailing of all responsible party cost letters. Assure all Medicare non-covered services have a signed “Advance Beneficiary Notification" on file. All self pay, deductible, co-insurance, Medi-Cal share of cost has been properly collected prior to services. Obtain initial financial information to qualify patients for pharmaceutical reimbursement programs and all other charitable programs. Prioritizing all tasks and duties as assigned.

Essential Values-Based, Leadership and Management Competencies: Demonstrates values-based competencies in line with the four core values that are the foundation of all activities performed by employees in order to achieve the Mission of the St. Joseph Health System.

Dignity: Demonstrates competence in communication and interpersonal relations.

Excellence: Demonstrates competence in continuous improvement, continuous learning, accountability, and teamwork.

Service: Demonstrates competence in customer/patient focus and adaptability.

Justice: Demonstrates competence in community orientation and stewardship.

Essential Functions:

• Determination of all payor types policy provision for accurate reimbursement.

• Determination of responsibility party payment responsibilities.

• Prepare / send cost letter agreements.

• Assure all billing system parameters are completed.

• Assure all required billing forms ABN, Financial Responsibility letters are appropriately completed and valid.

• Ability to interpret provider contracts.

• Re-Verification of patient policy benefits monthly.

• Prepare billing/collection financial files as needed.

• Obtain authorizations/re-authorizations on a timely basis and scan documentation into Electronic Medical record.

Additional Responsibilities:

• Review pharmacy activity logs daily.

• Scan all patient medical / financial documentation into the electronic patient chart.

• Maintain all necessary / required tracking logs / tools, per department guidelines.

• Handle daily correspondence expeditiously.

• Utilize follow-up systems within the billing systems to assist in daily work management.

• Performs other duties as assigned.

Knowledge / Skills / Abilities:

• Typing 40wpm

• Software knowledge ( Excel, Word )

• Medical Terminology

• Knowledge of HCPCS, ICD-9 and CPT codes.

• Experience within a healthcare and/or insurance carrier setting.

• Ability to problem solve independently.

Information Management:

• Treats all information and data within the scope of the position with complete confidentiality and security.

Risk Management:

• Cooperates fully in all risk management activities and investigations.

Safety Requirements:

• Is knowledgeable of, observes and complies with Home Health Network Codes of Safe Practice, safety policies and emergency procedures.

Minimum Position Qualifications:

• Education: High School Diploma or Equivalent

• Experience: Minimum 2 year experience in Healthcare and/or insurance carrier setting

Preferred Position Qualifications:

• 1-2 years prior home health agency/home infusion experience.

• License/Certification: LVN or RN

Environmental Conditions:

• Office environment

• Knowledge of proper procedures for handling exposure to communicable diseases and blood borne pathogens.

• Knowledge of the proper technique to handle exposure to hazardous material.

Physical Requirements: Defined on the attached Physical Demand Analysis.

Since 1988, St. Joseph Health, Home Care Services has been a trusted leader in home health, hospice and infusion pharmacy, helping clients throughout Orange County, Los Angeles County and the Inland Empire receive the quality care they need in the comfort of their home. A member of the St. Joseph Hoag Health alliance, St. Joseph Health, Home Care Services is guided by our core values of excellence, service, dignity and justice in everything we do. With over 700 caring employees, we are dedicated to restoring the health and well-being of clients and families at all stages of life’s journey.St. Joseph Health, Home Care Services provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, St. Joseph Health, Home Care Services complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Company: SJH Home Health Network