Patient Access Rep

Job Profile Summary

This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In addition, this role focuses on performing the following Patient Access duties: Performs the administrative and financial-clearance duties necessary to facilitate the procurement of clinical services by patients. Collects patient's necessary demographic and financial information from physician offices, acute-care entities, or the patients themselves, schedules services for patients, and handles referrals from primary care doctors to ensure patients are scheduled for recommended appointments/procedures, etc. An organizational related support or service (administrative or clerical) role or a role that focuses on support of daily business activities (e.g., technical, clinical, non-clinical) operating in a "hands on" environment. The majority of time is spent in the delivery of support services or activities, typically under supervision. An entry level role that typically requires little to no prior knowledge or experience, work is routine or follows standard procedures, work is closely supervised, and communicates information that requires little explanation or interpretation.

Job Overview

This position is responsible for interviewing inpatient and outpatients with a courteous and professional demeanor in order to obtain accurate and complete patient registration data. Responsible for collecting and documenting in hospital registration system demographic and financial information for scheduled visits and completing pre-service collection of patient liability (including, but not limited to deductibles, co-insurances, co-payments, etc.) and/or bad debt. This position is also responsible for verifying patient insurance, confirming benefits eligibility, performing pre-authorization, pre-certification, and/or notification as required by third party providers.

Job Description

Preferred Qualifications:

Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list. Other duties and responsibilities may be assigned.

1. Conducts Pre-Registration tasks for specified inpatients and outpatients prior to their date of service including: collects demographic, financial, and clinical information necessary for financial clearance of scheduled patients; obtains missing insurance information via patient's family or physician offices; and completes insurance verification using online electronic verification system or contacting payor directly.

2. Obtains consent for treatments and authorizations as necessary. Explains signature requirements to patients and patient's representatives in a manner that is easily understood by the patient or their representative.

3. Verifies the validity of insurance coverage via eligibility tools. Ensures the appropriate plan codes has been added to registration based on the information provided in the eligibility response. Educated on different insurance plans and coordination of benefits. Able to identify if any concerns with coverage after checking insurance eligibility.

4. Collects the appropriate information for auto and worker's compensation registrations including information collected from the responsible party including the auto or worker's compensation carrier, agent and/or employer. If full information is not collected, notes are properly documented as to why the information was not collected or available.

5. Notifies patient of financial liabilities as determined by insurance benefits, coverage limits, and appointment/procedure-specific charges.

6. Takes an active role in the collection of patient payments. Understands all collection policies and procedures that pertain to time of service collections. Communicates these policies effectively to patients following prescribed scripting. Understands the use of credit card devices in regard to payments and credits. Is aware of all types of credit cards accepted by the organization.

7. Posts collected payments in system of record and verifies appropriate dollar amount and volume are posted in compliance with department guidelines.

8. Provides Financial Counselor contact information to patients qualifying for state-sponsored financial assistance. Documents patient's financial state and related information in system of record for reference of hospital administration and billing.

9. Obtains authorization, pre-certification, referral, and/or notification as necessary. Attaches verification to patient's account and documents information in the system of record for reference of hospital administration and billing.

10. Takes personal responsibility to provide excellent customer service and delivers exceptional professional courtesy to all patients.

11. Interacts with physicians, nursing units, and office staff in a courteous and professional manner.

12. Maintains and hospital financial information confidentially in accordance with all hospital policy and any state or federal regulations such as the HIPAA Privacy & Security Standards.

13. Meets the requirements of area specific benchmarks related to productivity and customer service such as wait times, call monitoring score card scores, number of registrations or calls processed, etc.

Physical Requirements:

1. Frequent sitting, occasional standing or working, and lifting of 10-15 points.

2. May be exposed to dust and other typical office-like discomforts.

3. Manual dexterity using fine hand manipulations for computer keyboard operation.

4. Requires ability to see computer screen and read reports.

5. Requires ability to hear instructions from physicians and other clinical or nursing staff.

Skills & Abilities:

1. Computer literacy required including familiarity with word processing programs and electronic spreadsheets and facility in learning new applications. Ability to perform accurate data entry.

2. Strong customer service skills including excellent interpersonal and telephone skills.

3. High degree of tact is necessary due to frequent interaction with patients, physicians, and insurance companies.

4. Experience using computer-based, patient registration systems.

4. Thorough understanding of private insurance, Medicare, and Medicaid programs.

5. Knowledge of medical terminology.

6. Excellent organizational skills required with attention to detail. Ability to prioritize work and be flexible with work assignments.