Los Angeles, CA30+ days ago
Patient Access: Greets and registers patients in person or over the phone; Obtains demographics, preferred pharmacy, emergency contact, and insurance information; Enrolls patient using electronic system; Provides forms to patients and completes paperwork for requested services; Determines when language interpretation is needed; Orients patients to health services by providing direction to appropriate locations for services; Initiates and/or processes applications for a variety of reduced no-cost/low-cost programs, such as ATP and UMDAP; Verifies coverage and empanelment prior to scheduling; Identifies when authorization and/or letter of agreement may be needed; Identifies discrepancies in assignment and empanelment and appropriately refers complex cases to Patient Relations Representatives; Schedules patient visits by determining the appropriate providers and programs for patients; Ensures timely access to services by actively monitoring and coordinating multiple provider schedules and maintaining appointment templates for clinic providers; Re-verifies eligibility in the month of the appointment to financially clear patients for appointments, conducts patient outreach by phone and/or mail, explains coverage options, refers the patient to member services as needed, and cancels appointments; Checks-in patient for appointment to explain payment options, obtains signatures, collects fees, and keeps records of insurance and patient identification. Essential Job Functions: Interviews patients or their relatives and/or representatives to obtain identifying information, financial and other eligibility data; Determines the patients potential eligibility to enroll in specific health care programs based upon diagnosis, available medical information, type of medical/clinical services, and residency status; Enters and accesses data by utilizing various local and web-based information systems and databases to determine a patients financial eligibility; Evaluates financial data and resources to determine the patients ability to reimburse the County for health care services consistent with department policy; Completes or assists the patient in the completion of benefits forms for third-party resources; Contacts private insurance companies to verify coverage and to obtain authorization for services; Verifies existing governmental coverage for health care services, and screens for the patients potential eligibility to receive Medi-Cal or other no-cost/low-cost programs.