Discovery Representative

Summary The Discovery Representative assists underinsured and uninsured patients to determine eligiblity for financial assistance.
Records and maintains comprehensive documentation of all financial assistance activities.
Communicates with clients, attorneys, and patients on accounts and performs necessary actions to ensure payment and resolution of these accounts.
Models appropriate behavior as exemplified in MLH Mission, Vision and Values.
Education/Experience/Licensure Education/Formal Training Work Experience Credential/Licensure REQUIRED: High School diploma or equivalent.
Minimum of two (2) years of experience in collections and healthcare business office.
N/A PREFERRED: N/A N/A N/A SUBSTITUTIONS ALLOWED: N/A N/A N/A Knowledge/Skills/Abilities Knowledge of hospital and general insurance procedures.
Knowledge of mainframe, Trace, JDA, TN Care/Medicaid, Ability and Accurint websites.
General computer skills necessary to work effectively in an office enivornment.
Strong critical thinking skills.
Strong attention to detail skills.
Strong customer service skills in person and via telephone or e-mail.
Excellent organizational, verbal and written communication skills, including spelling and correct grammatical structure.
Ability to operate standard office equipment.
Ability to perform basic mathematics and calculate and tabulate numbers effectively to make adjustments to the patient account.
Ability to follow and verifies insurance guidelines/requirements.
Ability to prioritize and manage multiple task simultaneously, and to effectively anticipate and respond to issues as needed in a multi-faceted work enivornment.
Ability to understand and interpret complex written materials such as insurance matrices, Point of Service calculations and patient records.
Ability to develop solutions to complex problems, which require ingenuity, creativity, and innovativeness.
Ability to exercise independent judgment in making decisions and resolving complex problems related to general and technical aspects of the position.
Key Job Responsibilities Identifies and contacts patients who are uninsured or underinsured who may have difficulty meeting their financial responsibility and determines their ability to pay.
Determines if the uninsured patient is eligible for financial assistance and the eligibility amount by reviewing patient accounts to distinguish if services were medically necessary, review tax returns and other government assistance documentation such as unemployment check, food stamp, social security and disability letters, comparing more related accounts by reviewing Bridge for account activities Accesses various insurance websites and other account information and initiates phone contacts as needed to check eligibility.
Checks the Federal Poverty Guideline score and Tier status by reviewing the scoring process on the system.
Determines by the score and tier status if they have the authority to write off the account at 100%.
Works closely with the MLH facilities by updating the facility upon their request of a patient financial assistance status.
Corresponds through email, trace and Sharepoint to the reps inquiring if a patient is eligible for financial assistance prior to patient admission to the facility.
Maintains complete records of all patients applying for indigent or financial assistance to include the application, proof of income, the acceptance/denial letter, and any other applicable documentation.
Evaluates patient’s account by researching account history, gathering data and processing data to determine resolution.
Documents activity and patient communication on patient's accounts; scans appropriate documentation to patient's account.
Notifies patients by mail on their approval or denial status of financial assistance.
Assists with walk-ins who come to the office for financial assistance screening.
Requests interpreting services from the bilingual Rep to assist with the Hispanic as well as English patients.
Responds to any and all departmental correspondences including emails, faxes, incoming mail, voice-mails, and patient written disputes in a timely manner.
Physical Requirements The physical activities of this position may include climbing, pushing, standing, hearing, walking, reaching, grasping, kneeling, stooping, and repetitive motion.
Must have good balance and coordination.
The physical requirements of this position are: light work - exerting up to 25 lbs.
of force occasionally and/or up to 10 lbs.
of force frequently.
The Associate is required to have close visual acuity to perform an activity, such as preparing and analyzing data and figures; transcribing; viewing a computer terminal; or extensive reading.
The conditions to which the Associate will be subject in this position: The Associate is not substantially exposed to adverse environmental conditions; job functions are typically performed under conditions such as those found in general office or administrative work.