Job Description
JOB SUMMARY
The Insurance & Admission Specialist at North Mississippi Health Services is responsible for facilitating patient admission and discharge. This role operates under the guidance of the Office Coordinator and requires an experienced individual with strong organizational and communication skills to serve as a welcoming information source for patients, collect insurance details, paperwork, and payments, coordinate financial counseling and patient scheduling, and maintain accurate and comprehensive records to support efficient patient processing and a high quality patient experience.
| **JOB** **FUNCTIONS** |
| --- |
Customer Service:
• Greets patients in a positive, helpful, and courteous manner.
•Explains paperwork such as patient rights, financial responsibility, charity application, medical releases, etc.
• Answers and disperses intra and/or inter departmental phone calls and messages.
• Promotes good intra and inter departmental and public relations.
• Responds to inquiries from patients, family members and providers in regard to health benefits.
• Assists patients in the Indigent Drug Programs by selecting programs, completing and submitting the enrollment forms and the receipt of shipments.
Admission:
• Obtains and/or verifies insurance eligibility and benefits.
• Gathers required signatures on patient paperwork.
• Interviews patient or patient representative in person or over the telephone to obtain demographics and insurance information.
Discharge:
• Remains responsible for discharging patients.
• Performs cashiering duties.
• Receives payments on accounts.
• Schedules appointments and procedures.
• Provides financial counseling to patients and/or patient representatives to manage balances owed.
• Assists patients and/or patient representative in completing the Charity Application for financial assistance.
• Takes responsibility for accurate documentation (coding) of diagnosis and therapy administered.
• Provides financial folders of each patient to the Business Office.
Record Keeping:
• Processes, maintains, and scans records in a timely, accurate, and confidential manner.
• Electronically updates patient's records.
• Submits patient information/documentation timely and accurately to the appropriate department.
• Complies with all HIPPA Regulatory and Insurance policies in gathering and maintaining patient records; reports possible non-compliant cases to Supervisor, Department Manager, or Compliance Officer.
• Records patients insurance and demographic information.
• Expedites billing and payment processes by receiving, interpreting, and submitting all necessary information and documentation in an accurate and timely manner.
QUALIFICATIONS Education Education Level Education Details Required/Preferred High School Diploma or GED Equivalent or equivalent Required
And Associate's Degree in Business or related field Preferred
Licenses and Certifications
Licenses and Certifications Licenses and Certifications Details Time Frame Required/
Preferred
Work Experience Number of Years Work Experience Details Required/
Preferred 1-3 years 2 years of health care insurance, benefits, or collection experience Required
Knowledge Skills and Abilities
Knowledge, Skills, Abilities Required/Preferred Proficiency Excellent verbal and written communication skills; required. Required N/A Working knowledge of computer skills; required. Required N/A Knowledge of pharmacy and infusion therapy (drugs, supplies, pumps), preferred. Preferred N/A Knowledge of Diagnosis-Related Group (DRG) and coding, preferred. Preferred N/A Must be able to resolve member, provider, and client complaints regarding reimbursement issues. Required N/A Must be able to calculate and collect patient co-pays and/or co-insurance monies. Required N/A Must be able to efficiently and accurately complete admission/discharge process. Required N/A Must ensure compliance of departmental, regulatory, and HIPPA policies and procedures. Required N/A Must be able to identify problems/errors with drug vs. therapy admissions and propose possible solutions. Required N/A Must possess strong organizational and interpersonal skills. Required N/A Must provide customer service to infants, pediatrics, adolescents, adults and geriatrics. Required N/A Must be detail oriented. Required N/A Must work well within a team-oriented structure. Required N/A Must serve as a patient advocate. Required N/A Must be able to gather and share information with knowledge, tact, and diplomacy. Required N/A Must maintain patient confidentiality and adhere to HIPPA regulations. Required N/A Must identify and report problems outside the established parameters to the supervisor, along with recommendations for solutions. Required N/A Must make decisions that are conductive with the hospital’s overall Mission/Vision Statements. Required N/A Must comply with various legal and regulatory guidelines. Required N/A Must make decisions regarding ordering of supplies, notifying nurses of exceptional cases, and customer service functions. Required N/A
**SCOPE**
**Freedom To Act:**
**Problem Solving:**
**Impact:**
**Financial Responsibility:** * Sales Revenue Target Responsibility: * Approval Responsibility: * P & L Responsibility: * Assets Controlled: * Controllable Expenses (e.g., Payroll and other budgeted items): * Total Financial Responsibility: **Budget Responsibility** * Primary Budget Responsibility: * Shared Budget Responsibility:
• Greets patients in a positive, helpful, and courteous manner.
•Explains paperwork such as patient rights, financial responsibility, charity application, medical releases, etc.
• Answers and disperses intra and/or inter departmental phone calls and messages.
• Promotes good intra and inter departmental and public relations.
• Responds to inquiries from patients, family members and providers in regard to health benefits.
• Assists patients in the Indigent Drug Programs by selecting programs, completing and submitting the enrollment forms and the receipt of shipments.
Admission:
• Obtains and/or verifies insurance eligibility and benefits.
• Gathers required signatures on patient paperwork.
• Interviews patient or patient representative in person or over the telephone to obtain demographics and insurance information.
Discharge:
• Remains responsible for discharging patients.
• Performs cashiering duties.
• Receives payments on accounts.
• Schedules appointments and procedures.
• Provides financial counseling to patients and/or patient representatives to manage balances owed.
• Assists patients and/or patient representative in completing the Charity Application for financial assistance.
• Takes responsibility for accurate documentation (coding) of diagnosis and therapy administered.
• Provides financial folders of each patient to the Business Office.
Record Keeping:
• Processes, maintains, and scans records in a timely, accurate, and confidential manner.
• Electronically updates patient's records.
• Submits patient information/documentation timely and accurately to the appropriate department.
• Complies with all HIPPA Regulatory and Insurance policies in gathering and maintaining patient records; reports possible non-compliant cases to Supervisor, Department Manager, or Compliance Officer.
• Records patients insurance and demographic information.
• Expedites billing and payment processes by receiving, interpreting, and submitting all necessary information and documentation in an accurate and timely manner.
QUALIFICATIONS Education Education Level Education Details Required/Preferred High School Diploma or GED Equivalent or equivalent Required
And Associate's Degree in Business or related field Preferred
Licenses and Certifications
Licenses and Certifications Licenses and Certifications Details Time Frame Required/
Preferred
Work Experience Number of Years Work Experience Details Required/
Preferred 1-3 years 2 years of health care insurance, benefits, or collection experience Required
Knowledge Skills and Abilities
Knowledge, Skills, Abilities Required/Preferred Proficiency Excellent verbal and written communication skills; required. Required N/A Working knowledge of computer skills; required. Required N/A Knowledge of pharmacy and infusion therapy (drugs, supplies, pumps), preferred. Preferred N/A Knowledge of Diagnosis-Related Group (DRG) and coding, preferred. Preferred N/A Must be able to resolve member, provider, and client complaints regarding reimbursement issues. Required N/A Must be able to calculate and collect patient co-pays and/or co-insurance monies. Required N/A Must be able to efficiently and accurately complete admission/discharge process. Required N/A Must ensure compliance of departmental, regulatory, and HIPPA policies and procedures. Required N/A Must be able to identify problems/errors with drug vs. therapy admissions and propose possible solutions. Required N/A Must possess strong organizational and interpersonal skills. Required N/A Must provide customer service to infants, pediatrics, adolescents, adults and geriatrics. Required N/A Must be detail oriented. Required N/A Must work well within a team-oriented structure. Required N/A Must serve as a patient advocate. Required N/A Must be able to gather and share information with knowledge, tact, and diplomacy. Required N/A Must maintain patient confidentiality and adhere to HIPPA regulations. Required N/A Must identify and report problems outside the established parameters to the supervisor, along with recommendations for solutions. Required N/A Must make decisions that are conductive with the hospital’s overall Mission/Vision Statements. Required N/A Must comply with various legal and regulatory guidelines. Required N/A Must make decisions regarding ordering of supplies, notifying nurses of exceptional cases, and customer service functions. Required N/A
**SCOPE**
**Freedom To Act:**
**Problem Solving:**
**Impact:**
**Financial Responsibility:** * Sales Revenue Target Responsibility: * Approval Responsibility: * P & L Responsibility: * Assets Controlled: * Controllable Expenses (e.g., Payroll and other budgeted items): * Total Financial Responsibility: **Budget Responsibility** * Primary Budget Responsibility: * Shared Budget Responsibility:
About North Mississippi Health Services
North Mississippi Health Services (NMHS) is a diversified regional health care organization serving 24 counties in north Mississippi and northwest Alabama and is one of the largest employers in Mississippi with over 6,900 employees. NMHS covers a broad range of acute diagnostic and therapeutic services offered through North Mississippi Medical Center (NMMC) in Tupelo, Community Hospital System, and North Mississippi Medical Clinics. NMHS strives to improve the health for people in this region by providing conveniently accessible and cost-effective healthcare of the highest quality.
