Role Description Performs a variety of registration, insurance verification, scheduling and billing duties in support of inpatient and outpatient access to medical services. Completes complex tasks. May aid or train other Representatives in responsibilities. - Performs admissions, registration and scheduling activities. - Obtains necessary demographic and insurance information and enters data into computer system, which may include patients on Medicare/Medicaid. - Verifies patient insurance coverage and other related data. - Obtains patient insurance authorization required for services. - Documents authorization approvals and denials in computer systems. - May financially screen patients, evaluating and assessing all self-pay patients pre-registered or inpatient/outpatient, to establish method of payment. - Informs and counsels patient/patient representative regarding available financial assistance. - Collects money due from patient at time of service. - May perform billing, receivable and related functions. - May follow through on any open self-pay accounts including monthly payment amounts for purposes of collection. - Assists and/or trains new employees as instructed by supervisor or manager. - Performs related duties as required. Qualifications - High School Diploma or equivalent required. - 3-5 years of relevant experience, required. - Remote Monday-Friday 9am-5pm. Company Description The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).

• Request and obtain prescriptions and authorizations from medical offices and insurance companies • Follow up with providers and payers to ensure timely receipt of required documentation • Resolve questions related to Certificates of Medical Necessity (CMN) and participating provider requirements • Re-verify patient eligibility for ongoing services • Maintain accurate, compliant documentation in accordance with HIPAA and regulatory standards • Communicate with patients, provider offices, and internal teams to resolve access-related issues

• Reviewing daily inpatient and observation admission reports to identify accounts requiring payer notification. • Submitting “Notification of Admission” requests to commercial, Medicare Advantage, Medicaid Managed Care, and other third-party payers in accordance with payer, regulatory, contractual, and client-specific requirements. • Verifying coverage, eligibility, and account information prior to submission to support clean, accurate notifications. • Documenting confirmation numbers, reference numbers, payer responses, and related communications in designated client and Guidehouse systems. • Monitoring pending notifications, follow up on outstanding requests, and resolve issues within required timelines. • Escalating accounts at risk for missed notification deadlines, authorization-related denials, or reimbursement impact. • Collaborating with Utilization Review, Case Management, and other operational teams to obtain supporting clinical or account information as needed. • Maintaining current working knowledge of payer-specific notification requirements, client workflows, and standard operating procedures. • Identifying trends contributing to notification delays, defects, or denials and communicate improvement opportunities to leadership. • Supporting quality assurance reviews, reporting activities, training reinforcement, and continuous performance improvement initiatives. • Meeting or exceeding productivity, quality, timeliness, and service level expectations established by Guidehouse and client organizations.

• Perform insurance verification and authorization functions that support Patient Access Services • Ensure compliance with department standards and billing requirements • Complete authorization initiation requests with payers for all service lines • Validate existing authorizations requested by providers • Provides necessary information regarding authorization numbers and patient demographic information to appropriate staff • Responds to "provider orders" for tests and procedures • Obtains authorizations for visits required by various payers