Bus Svc Rep Entry - Med Ins/Pre-Auth

Performs registration functions in an effective and efficient manner to enhance coding, billing and case coordination efforts.

Makes appropriate independent decisions that require assessment, reasoning and resolution regarding financial requirements to assure appropriate reimbursement for both the patient and the hospital.

Performs prior authorizations for patients admission/surgeries to ensure reimbursement for services and participates in denials management activities. Interprets and applies hospital policies regarding financial resources and arrangements.

Uses exquisite customer service skills when handling patient encounters/issues.

Certifications: , Education: Experience In Lieu of Education Work Experience:

Keyboarding ability required. Deals effectively with stressful situations and maintains composure at all times. Ability to prioritize and multi-task for long periods of time. Insurance knowledge and basic understanding.

Essential Functions

Accurately explains and completes registration and admitting forms. Obtains signatures from patients and policyholders.

Explains and gets patient signatures for Consents, Assignment of Benefits, ABN's and Notice of Non Coverage forms.

Communicates detailed information clearly, concisely, actively, and in a timely manner.

Completes Medicare Secondary Payer (MSP) form in accordance with Medicare laws. Follows up on necessary information.

Interprets insurance coverage and benefits to patients.

Interviews and identifies patients with the potential for financial hardship and/or without third-party coverage and works with the patient for resolution. Provide essential information regarding Carle's Financial Assistance Program or payment arrangements

Obtains, updates and verifies patient demographics, insurance and co-pays and Primary Physicians.

Performs chart management duties proficiently by ordering, sending, and receiving charts when necessary. Creates new clinic charts and medical record numbers for new patients.

Performs insurance eligibility verification by using Nebo for payer information when possible. Understands terms and information listed on Nebo reports.

Performs prior authorizations for patients admission/surgeries to ensure reimbursement for services and participates in denials management activities.

Receives and posts co-payments as identified by third-party payers or patient insurance cards. Maintains cash drawers and balances according to procedures.

Registers all patients at each visit utilizing established policies for the capture of complete and up-to-date patient and insurance information.

Reviews, analyzes, and communicates registration errors to HRC management for quality improvement. Strives 5% or less error rate.

Scans all required patient information into software systems so that information is retrievable and accessible by hospital staff.

Understands, reviews and explains Patient Rights & Responsibilities, Notice of Privacy, and other pertinent admitting information to the patient and/or family member.

Find it here.

Discover the job, the career, the purpose you were meant for. The supportive and inclusive team where you can thrive. The place where growth meets balance - and opportunities meet flexibility. Find it all at Carle Health.

Based in Urbana, IL, Carle Health is a healthcare system with nearly 16,600 team members in its eight hospitals, physician groups and a variety of healthcare businesses. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet designations, the nation's highest honor for nursing care. The system includes Methodist College and Carle Illinois College of Medicine, the world's first engineering-based medical school, and Health Alliance. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com.