Patient Access Rep

Major Responsibilities:

• Demonstrate superior skills in three of five areas of Patient Access. Proficiency will be demonstrated by being ranked as "exceeds expectations" in three key areas: quality of work (using measures for accuracy and completeness), patient satisfaction ( using measures in the area of friendliness, courtesy and ease of registration process), and efficiency (using measures related to timeliness of work, and work volume).
  • 1)Hospital Inpatient; the main admitting functions related to patients moving from ER or outpatient areas to bedded status as well as the processes of managing direct admissions
  • 3)Hospital Outpatient: The main outpatient registration areas of the hospitals, including but not limited to procedural areas and diagnostic testing areas.
  • 4)Pre-Access Scheduling: all areas under the scope of the scheduler job description.
  • 2)Pre-Access Insurance Verification: all areas under the scope of the Verifier job description
• When creating new registrations for walk-in patients, responsible for the identifying insurance coverage, the benefits available, patient out-of-pocket expenses, and collecting co-insurance and co-payments.
  • 1)Uses electronic systems to confirm coverage while patient is present and discussing the findings with the patient. Follow established department policies to resolve issues related to patient's eligibility for coverage or issues in in-network status for the patient using Advocate's network.
  • 2)When working uninsured patients, screen for urgent status cases and follow charity procedure. Refer as appropriate for additional financial counseling. Engage leaders to resolve questions on urgent versus non-urgent/elective care.
  • 3)When assisting walk-in patients, screen orders for compliance with policy. Work with physicians, Care Coordinators, and clinical department leaders to communicate and resolve issues related to order quality and acceptable standards.
  • 4)Collecting appropriate out of pocket expenses in accordance with policy.
  • 5)Screens physician orders against medical necessity criteria using compliance checker software. Follows procedures to obtain additional diagnosis information from physicians and initiates the Medicare Advance Beneficiary Notice of Non-Coverage to patients as appropriate.
• Responsible for performing all job duties in a way that conforms to our customer service philosophy and consistent with our "AIDET" standards
  • 1)Explain the nature of our work, why we ask for demographic, socio-economic, and financial information. Explain how we safeguard their information and use it to provide better care for them.
  • 3)Hand-patients off to the next area with a clear "thank you."
  • 4)Introduce the patient to our services, what they can expect while under our care. Utilize appropriate etiquette in all communications.
  • 2)Provide the patient with information on the likely time spent in the service area (duration) including time in registration and time in clinical service.
• Provides point of entry reception service in all Patient Access departments in order to create the highest levels of patient satisfaction, to minimize wait times, and to assist with patient throughput during the patient arrival process.
  • 1)Interacts with patients using AIM. Greets patients and families promptly and with courtesy, assisting with questions and directions.
  • 2)Begins financial clearance process by reviewing patient orders and confirming reason for patient visit verbally. Communicate discrepancies or questions to clinical partners. Obtain verbal/fax orders from physicians if needed. Ensure that complete narrative diagnosis and signatures are written on order.
  • 3)Partners effectively with ancillary units to facilitate patient arrival. Must be familiar with testing requirements (i.e. fasting) in order to gauge appropriateness of patient arrival. Communicates patient arrival to departments and call areas if STAT process is required.
  • 4)Maintains knowledge of hospital locations and services. Able to communicate with clear directions
  • 5)Answers all incoming telephone calls according to established department procedure.
  • 6)Directs or escorts patients to service location if required. Works in conjunction with Guest Services to provide escort service to patients.
  • 7)Works as a team player to assist with patient flow management during peak patient volume times.
• Assumes responsibility as a preceptor/trainer. Provide registration quality reviews as requested by leader.
  • 1)Serves as a preceptor/trainer for new hires in training or for low performers who require mentoring for registration accuracy. May be called upon to perform registration QA reviews for patient access associates or decentralized associates when needed.
  • 2)Participates on the Peer Interview team for Patient Access departments or decentralized points of registration.
  • 3)Participates in pilot patient access projects and provides feedback on process improvements for registration.

Education/Experience Required:

• -High school diploma - 2 years of direct experience in an acute hospital or hospital-based ambulatory environment preferred. -Knowledge of third party payers, regulatory compliance, and industry standards. -Knowledge of medical terminology through completion of either coursework or certification

Knowledge, Skills & Abilities Required:

• -Typing 25 words per minute -Excellent communication and customer service skills. -Office equipment knowledge, including computer skills -Demonstrated competency in the tools in use in the Patient Access department.
• None

Physical Requirements and Working Conditions:

• Ability to work weekends, holidays, and different shifts in order to accommodate staffing needs may be required. Must be flexible and possess ability to work in any patient access setting required. Must possess communication skills in order to perform complete patient interviews, type information into the appropriate fields, and to verbalize patient instructions. These tasks may be performed face to face with patients and family members, or over the phone with hospital departments and physician offices.
• Must be able to sit, stand, walk, lift, carry, squat, and bend frequently as well as twist, rotate, and kneel occasionally throughout the workday.
• Frequently lifts up to 10 lbs. and occasionally lifts between 20 lbs. or more. This occurs when moving equipment and supplies and when transporting patients and/or charts.
• Must be able to push/pull up to 50 lbs. with assistance.
• Must have functional speech and hearing.
• Must be able to use hands with fine motor skills for keyboard data entry.
• Exposed to a normal office environment.
• Operates all equipment necessary to perform the job.
• Must be able to work a flexible schedule to support the needs of the department.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.