Patient Access Representative 3 (On-Site)

CORE JOB SUMMARY

The Patient Access Representative 3 (On-Site) oversees the registration and financial clearance activities that will facilitate reimbursement for services rendered by the departmentand serves as functional expert for department peers.

CORE JOB FUNCTIONS

1. Obtains, confirms, and enters demographic, financial, and clinical information necessary for financial clearance of scheduled patient accounts.

2. Contacts patients’ families or physicians’ offices to obtain missing insurance information.

3. Verifies insurance and confirms insurance eligibility of patient coverage benefits, notifying patient and referring physician in the event of failed eligibility.

4. Collaborates with scheduling departments to identify add-on patients.

5. Obtains necessary authorizations, pre-certifications, and referrals.

6. Notifies patients of liabilities prior to date of service and collects funds.

7. Maintains appropriate records, files, and accurate documentation in the system of record.

8. Serves as a lead resource for lower-level Patient Access Representatives.

9. Recommends new approaches to management for enhancing performance and productivity.

10. Adheres to University and unit-level policies and procedures and safeguards University assets.

This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.

CORE QUALIFICATIONS

Education:

High school diploma or equivalent required

Certification and Licensing:

Not Applicable

Experience:

Minimum 3 years of relevant experience

Knowledge, Skills and Attitudes:

· Knowledge of generally accepted accounting procedures and principles.

· Skill in completing assignments accurately and with attention to detail.

· Ability to process and handle confidential information with discretion.

· Ability to work independently and/or in a collaborative environment.

· Ability to communicate effectively in both oral and written form.

Department Specific Functions

1. Serves as Lead resource and functional expert.

2. Ensures smooth patient flow.

3. Provides supervisory coverage in the absence of Supervisor.

4. Identifies and recommends new approaches to management for enhancing team performance and productivity.

5. Projects a welcoming professional demeanor.

6. Interacts and works effectively with patients of all ages, and the healthcare team to ensure a favorable first impression and positive patient experience.

7. Coordinates wide range of functions from prearrival to discharge utilizing multiple systems including but not limited to: EPIC MyChart, Grand Central ADT, Cadence, Prelude, Radiant, OP Time, Care Everywhere, Resolute, Nice inContact Communication, and Aria Oncology simultaneously and independently to service patients promptly in a fast paced, constantly changing environment.

8. Performs pre-service validation prior to patient’s appointment for in person or virtual visits.

9. Assists patients in navigating self-serve technology options including but not limited to MyChart and Self check-in kiosks, in person or remotely.

10. Coordinates patient flow to ensure timely check-in and arrival to service area.

11. Obtains, confirms, and accurately enters and updates demographic, financial, and clinical HIPAA protected information.

12. Reviews real time eligibility insurance responses and/or master contract tool and updates coverages as needed.

13. Conducts critical communication with patients or legal guardian facilitating the understanding of and obtaining signature on legal, ethical, and compliance related documents that must be presented and thoroughly explained to the patient prior to services being rendered including but not limited to: to Consent for Treatment and Conditions of Admissions, Advance Directives, HIPAA Notice of Privacy, No Surprise Billing, Good Faith Estimate, Off Campus Medicare Co-insurance and Advance Beneficiary Notices, and Medicare Secondary Payer Questionnaire.

14. Serves as gatekeeper, performs insurance verification, and obtains referrals and/or authorizations as needed.

15. Provides financial counseling services at check-in, explains benefits, creates estimates, and notifies patients of self-pay liabilities including co-pays, deductibles, co-insurances, global self-pay packages, and previous balances for both hospital technical and professional components and collects thereby reducing AR, Bad Debt, and collection costs by collecting patient’s financial responsibility upfront.

16. Promotes the use of effective methods of communication and collaborates with providers and clinical team schedulers in coordinating and scheduling complex follow up care onsite or remotely.

17. Handles high volume of incoming and outgoing calls promptly. Answers and triages incoming calls, listens to patient/customers’ needs, responds to questions, provides helpful solutions, directs calls, and documents messages using appropriate software in accordance with established protocol.

18. Collects and processes large amounts of currency and performs end of day cash-drawer reconciliation and timely bank deposits.

19. Assists department in meeting all established key performance indicator goals: Co-pay, Previous Balances, Estimate Collections, Patient Satisfaction, Accuracy Rates, and Processing Time.

20. Maintains a close working relationship and open communication with all members of the healthcare team to ensure a seamless check in, check out, clinic flow and positive experience for patients and caregivers.

21. Recognize, analyze, solve, and de-escalate issues that may arise during workday by applying sound judgement and critical thinking.

22. Ensures proper physical distancing is always maintained following established guidelines.

23. Works with healthcare team to resolve unique situations and troubleshoot issues.

24. Cross trained to carry out all Front-End Revenue Cycle and Clinical Support functions and able to float across all areas and assist as needed.

25. Knowledge of health care regulatory guidelines and compliance requirements including but not limited to: OSHA, HIPAA, JC, AHCA, EMTALA, and CMS.

Job Type: Full-time

Pay: $18.00 - $29.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Employee discount
• Health insurance
• Life insurance
• Paid time off
• Parental leave
• Professional development assistance
• Retirement plan
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday
• Weekends as needed

Education:

• High school or equivalent (Preferred)

Experience:

• Computer skills: 1 year (Preferred)
• Customer service: 3 years (Preferred)
• Medical terminology: 3 years (Preferred)

Work Location: In person