Home Care - Service Representative Job

Children's Health - Service Representative Careers

Job Number: 52567

Location: Plano, TX

Date Posted: 1-14-2018


Position Summary:

Completes all central intake functions for the Home Care Department including taking patient referral information over the phone, verifying benefits and insurance eligibility, registering patient in the electronic system, inputting accurate referral data regarding patient's status in the system, tracking plan of care compliance, maintain expired authorization information, scheduling patient visits, and assisting patient families in navigating insurance benefit requirements. This position is accountable for delivering excellent customer service, obtaining accurate information and maintaining a smooth intake workflow in the Home Care offices. Results expected are patient and provider satisfaction, in addition to complete, accurate data for appropriate financial outcomes.

Job Responsibilities:

  • Referral Processing: Make initial contact with the patient family to verify location of home services and ensure all patient demographic information is correct. Register patient in electronic system with accurate patient demographic and insurance information. Verify benefits of patient to determine authorization requirements in order to access home care services. Maintain up-to-date Active Census List data based on regulatory standards. Ensures clinical information coincides with orders and obtained authorizations for services. Ensure smooth scheduling and authorizations workflow within the department.
  • Plan of Care Compliance: Obtain physician's signature on plan of care documents. Update Active Census List daily with information regarding status, comments and plan of care frequency from documentation, as well as staffing changes. Contact physician office personnel in attempt to communicate needs of the department, such as obtaining physician's signature on paperwork or processing new referrals. Ensure number of schedule visits match authorized visits available to maintain plan of care compliance. Enter charges from completed visit information into electronic system when field staff needs assistance.
  • Insurance Authorizations: Verify third party coverage for all visits to ensure all services are reimbursed (through real time eligibility, using the internet or by phone to the payer). Understand the complexities of and complete all third party payment requirements by obtaining timely referrals and accurate authorizations within the required timelines. Request payments at the point of service when appropriate. Make appropriate referrals to financial counseling for uninsured and underinsured patients. Assist guarantors with questions related to the complexities of the healthcare reimbursement process.
  • Customer Service: Answer phone calls within four rings, obtain appropriate information, route calls as needed, research issues and make adjustment to patient / staff schedules as needed. If bilingual will complete validation training through Language Access Services Department in order to interpret for staff and non-English speaking patients. Maintain Authorization Expiration Report to ensure patient re-assessments are completely timely and new authorizations are obtained in order to prevent breaks in home care services.
  • Schedule multidisciplinary visits (Level 2); template management (Level 2); train other employees (Level 3); and committee involvement (Level 3).

Education and Experience:

  • High school diploma or GED - required
  • Two-year Associate's degree - preferred
  • Customer Service, Home Care scheudling, or EPIC scheduling/registration experience - preferred
  • Bilingual in Spanish - preferred

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