Patient Access Representative I / II / Senior - Bellaire Spine Orthopedics

Medical Necessity Compliance Specialist

Responsible for ensuring medical necessity compliance, verifying eligibility, and posting payments.

Position Key Accountabilities :

1. Obtains demographic, insurance and financial information from patient or guarantor. Enters information in computer system with a high degree of accuracy.

2. May schedule patient appointments and enter required information in the computer system in an accurate and timely manner.

3. Explains all required forms to the patient or guarantor and obtains the necessary signatures.

4. Ensures medical necessity compliance by obtaining necessary data, reviewing Compliance System, communicating information to patient or guarantor and obtaining necessary signatures.

5. Protects the financial integrity of the facility by collecting patient liability, establishing payment arrangements, discussing payment options and screening for eligibility. Completes complex financial counseling including the review and submission of charity applications. Identifies alternative resources for financial reimbursement.

6. Verifies insurance eligibility and benefits and ensures all notifications and authorizations are completed within the required timeframes.

7. Posts payments in the computer system and generates the appropriate patient receipts.

8. Communicates in an effective and professional manner with Physicians, Care Management, ancillary departments, nursing units, physicians' office staff, insurance companies, as well as patients and their families. Completes thorough and accurate documentation.

9. Adheres to all university policies, procedures, and standards, within budgetary specifications, including time management, supply management, productivity, and accuracy of practice.

10. Promotes individual professional growth and development by meeting requirements for mandatory / continuing education, skills competency, supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.

11. Performs other duties as assigned.

Certification / Skills :

Ability to multi-task. Proficient typing / keyboarding skills.

Minimum Education :

High School Diploma or equivalent

Minimum Experience :

One (1) year of experience in a hospital or medical business office setting.

Physical Requirements :

Exerts up to 50 pounds of force occasionally and / or up to 20 pounds frequently and / or up to 10 pounds constantly to move objects.

Security Sensitive :

This position is a security-sensitive position pursuant to Texas Education Code 51.215 and Texas Government Code 411.094. To the extent that a position requires the holder to research, work on, or have access to critical infrastructure as defined in Texas Business and Commerce Code 117.001(2), the ability to maintain the security or integrity of the infrastructure is a minimum qualification to be hired for and to continue to be employed in that position. Personnel in such positions, and similarly situated state contractors, will be routinely reviewed to determine whether things such as criminal history or continuous connections to the government or political apparatus of a foreign adversary might prevent the applicant, employee, or contractor from being able to maintain the security or integrity of the infrastructure. A foreign adversary is a nation listed in 15 C.F.R. 791.4.

Residency Requirement :

Employees must permanently reside and work in the State of Texas.