Patient Access Rep II - Insurance Verifier

Catholic Health Initiatives Pasadena, TX
Patients Medical Center (PMC) provides inpatient and outpatient medical and surgical services to residents of Pasadena, Deer Park, La Porte, Baytown, and Clear Lake. The facility includes 53 medical/surgical beds, eight ICU beds and three endoscopy rooms, and offers a range of primary and specialized services—wound care, general surgery, gastroenterology, occupational health, heart and vascular, women's services, diagnostic imaging, outpatient rehab services, and sleep disorders.


Assist in providing access to services provided at the hospital. Knowledge of all tasks performed in the various Verification/Pre-certification area is necessary to provide optimum internal and external customer satisfaction and provide the opportunity for accurate reimbursement. The position basic function is for the verification of eligibility/benefits information for the patient's visit, obtaining Pre-cert/Authorization/Notifying Third Party payers within compliance of contractual agreements with a high degree of accuracy. Responsible for maintaining knowledge of HMO's, PPO's, Commercial/Governmental payers and System/Entity specific hospital contracts with Third Party payers. Maintaining knowledge and adhering to third party payer contractual agreements minimizing the Hospital's financial risk for claim denials thus maximizing reimbursement for services rendered. Will be responsible for maintaining knowledge of the Financial Policy and deployment of practices used with Patient Access to resolve the patients' accounts.


Education and Licensure


* High School Diploma/GED

Minimum Experience

* One (1) years of experience

Minimum Knowledge, Skills, and Abilities

* Excellent customer service skills

* Excellent Written/verbal communication skills

* Math skills

* Computer literate

* Detail oriented

* Basic knowledge of medical terminology


1. Performs collection functions and financial assistance for payment methods

2. Conducts interviews with patients and/or family members

3. Collect and/or negotiate point of service payments or link to financial assistance programs

4. Must be capable of articulating information in a courteous, clear and informative manner to patients, guarantors, family members, clinical staff, other hospital personnel, vendors, physicians, and their office staff

5. Convey estimates of the patient responsibility portion of the billed cost of service to patients under deductible, coinsurance, and standard co-pay benefit designs based on established charge estimates for common procedures

6. Counsels patients regarding their third-party coverage, financial responsibility, and billing procedures

7. Review patient account summaries of unbilled charges, billing, payments, and collection activities

8. Obtain all forms required for patients potentially qualifying for financial assistance

9. Review and monitor accounts for inpatients and initiate proper action

10. Ensures payors are listed accurately, pertaining to primary, secondary, and/or tertiary coverage and billing when a patient has multiple third party/governmental payors listed on an account.

11. Process patient accounts and deploy established policies to resolve insurance issues with patient accounts with/without supervision i.e. conference calls with employer, payor and physician office staff

12. Initiate pre-cert for in-house patients when required, obtaining pre-certification reference number, approved length of stay, and utilization review company contact person and telephone number