Ambulatory Services Rep II

 
Position: Ambulatory Services Rep II

Job ID: 154253

Location: US-TX-Houston

Department: PSYCHOLOGY SERVICE

Talent Area: Administrative Support

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8am-5pm

About Texas Children's Hospital

Since 1954, Texas Children’s has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children’s hospital in Texas, and among the top in the nation by U.S.News & World Report as well as recognition from Houston Business Journal as one of this city’s Best Places to Work for ten consecutive years. Texas Children’s comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Center for pediatric research; Texas Children’s Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children’s Hospital West Campus, a community hospital in suburban West Houston; and Texas Children’s Hospital The Woodlands, the first hospital devoted to children’s care for communities north of Houston. We have also created the nation’s first HMO for children, established the largest pediatric primary care network in the country and a global health program that is channeling care to children and women all over the world. Texas Children’s Hospital is also academically affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation. To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org. Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Summary:

We are searching for an Ambulatory Services Representative- Insurance Verification - someone who works well in a fast-paced setting. In this position, you will provide excellent customer service as the first contact for patients, providers and staff accessing ambulatory clinics. You will expedite the outpatient check-in and check-out processes by reviewing appointment status using electronic appointment system to view information regarding appointment, insurance, and history. You will also collect pre-visit payments and communicate with the clinic liaison regarding factors impacting the patient visit and general clinic-patient flow. You will also secure the financial integrity of the patient's account by verifying benefits and obtaining referrals, authorizations, and pre-certifications.

 

Think you’ve got what it takes?



Responsibilities :

  • Obtains and verifies patient demographic data for each encounter
  • Maximizes collection by reviewing patient notes for amounts quoted during pre-admission process and collects for non-preadmitted services as appropriate.
  • References Hospital contractual agreements with insurance companies to obtain authorization for services.
  • Verifies insurance benefits and identifies correct plan codes that drive reimbursement (i.e., Capitated allowance vs. per diem or discount of charges.)
  • Refers financially related issues to Business Services. Refers to/consults admissions department for patients arriving with incomplete or complex admission accounts.
  • Utilizes system work queues to follow up on accounts pending general pre-certification and benefits so that accounts on bill hold are minimized.
    Confirms receipt of insurance referrals per departmental guidelines.
  • Utilizes work queues to follow up on payor specific accounts pending authorization.
  • Serves as clinic/family resource regarding managed care questions


Qualifications:

  • High school diploma or GED required
  • 2-years’ experience in customer service required
  • Healthcare and/or Pediatric experience preferred
  • Bilingual in Spanish/English preferred


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