Patient Coverage Representative

Department:

Status:

Benefits Eligible:

Hours Per Week:

Schedule Details/Additional Information:

Monday- Friday 8:30-5:00 REMOTE POSITION

Pay Range:

Ensures the verification of insurance information received from various points of contact, including patients, payors, and other team members (inside and outside the revenue cycle). Uses multiple tools in Epic to ensure information is updated, ensuring billing accuracy.

Major Responsibilities:

• Receives incoming calls from patients as well as business office team members to perform coverage updates. Updates information in the Electronic Health Record(s) (EHR) to ensure coverage is verified and accurate. Ensures appropriate steps are taken to initiate claims on affected transactions.
• Performs updates based on Visit Filing Order changes daily, ensuring claims are sent to the correct primary and/or secondary payor.
• Reviews electronic eligibility transactions returned for patients with upcoming services, as well as for services that have already been billed to the patient, performing the necessary updates to coverage as needed to ensure accuracy of coverage information.
• Sends and receives Customer Relationship Management requests (CRM) to communicate with other team members in the business office regarding patient-initiated insurance concerns.
• Follows up on patient-initiated insurance changes through the EHR Patient Portal and makes updates as necessary.
• Performs guarantor account updates based on patient-initiated requests, ensuring the appropriate guarantor type is being used based on billing requirements.
• Updates hospital account records (HARs) and visits to ensure Smart Chart identified data discrepancies are corrected.
• Works other EHR workqueues related to patient demographic, guarantor, and coverage information as needed.

Licensure, Registration, and/or Certification Required:

• None Required.

Education Required:

• High School Graduate.

Experience Required:

• Typically requires 2 years of experience in health care, with focus on registration, insurance, and billing.

Knowledge, Skills & Abilities Required:

• Knowledge and understanding of Revenue Cycle-specific insurance and billing procedures preferred.
• Previous data entry experience and demonstrated proficiency with emphasis on speed with accuracy.
• Good organizational ability as well as solid written and verbal communication skills.
• A basic understanding of EHRs, with the ability to gain deeper knowledge.
• Knowledge of Medicare, Medicaid and third-party payors.
• Knowledge of medical terminology.

Physical Requirements and Working Conditions:

• Must be able to sit most of the workday.
• Must be able to lift up to 10 lbs. occasionally.
• Operates all equipment necessary to perform the job.
• Exposed to a normal office or home office environment.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training

• Premium pay such as shift, on call, and more based on a teammate's job

• Incentive pay for select positions

• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs

• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability

• Flexible Spending Accounts for eligible health care and dependent care expenses

• Family benefits such as adoption assistance and paid parental leave

• Defined contribution retirement plans with employer match and other financial wellness programs

• Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.

About Advocate Health 

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.