Patient Access Representative - Days (Ft)

JOB SUMMARY

At Citizens Medical Center, the Patient Access Representative position is responsible for obtaining and entering accurate demographic and insurance information in the electronic health record (EHR) on patients presenting at the various entry points of the facility. The Patient Access Representative employs effective communication skills, promoting excellent customer service in every interaction. This position coordinates insurance verification on all admissions to Citizens Medical Center ensuring coverage meets standards of admission and order criteria. This position is also required to adhere to all departments, hospital, governmental and/or any other healthcare licensing agency requirements related to the Emergency Medical Treatment and Labor Act (EMTALA) and the Health Insurance Portability and Accountability Act (HIPAA).

Job Specific:

All

• Promotes a positive work environment and contributes to a dynamic team focused work unit that actively helps one another to achieve optimal departmental and organizational results.
• Communicates openly in a non-judgmental manner and in a professional demeanor during all interactions with customers and co-workers.
• Contributes to departmental and hospital patient experience. Proactively seeks solutions to address patient issues and concerns. Alerts management in a timely manner to any unusual and/or difficult situations impacting the level of service.
• Consistently takes the necessary steps to ensure that protected health information remains private and confidential, according to established State and Government Privacy Rule guidelines.
• Organizes time effectively, minimizing incidental overtime and sets priorities. Utilizes time between heavy workloads efficiently and helps other team members.
• Displays initiative to improve job functions. Demonstrates adaptability and flexibility during changing demands. Offers suggestions to streamline process for efficient patient flow.
• Seeks opportunities to expand learning beyond baseline competencies with a focus on continual development.
• Obtains and records accurate demographic and insurance information on patients by interviewing patients, family members and physicians. Ensures that the correct insurance plan codes are utilized for the billing process. (EF)
• Explains the consent forms, obtains signatures on the forms, and responds to any questions in a professional manner. (EF)
• Uses patient identifiers consistently to properly identify patients and the correct medical records. Refrains from issuing new medical record numbers to patients with existing accounts. (EF)
• Meets goals set by the department (e.g., registration error rate, productivity/activities per hour, etc.).
• Ensures that ordered services meet established medical necessity criteria when applicable. (EF)
• Collects payments based on pre-determined information. Performs insurance verification to determine patient out of pocket expenses for services. If applicable, offers payment options after the minimum required payment has been received. (EF)
• Fulfills monthly goals for cash collection. Assures collections attempts are 100% (All patients with a potential balance are approached.)
• Accurately posts and receipts patient payments. Balances cash drawer daily; follows the department policy related to cash drawers and cash receipting. (EF)
• Works on other duties, pulls orders, and pre-registers patients over the phone as required

Registration:

• Knowledgeable regarding specific procedures and tests, as well as insurance requirements.
• Understands pre-authorizations importance, as well as preparations needed for testing.
• Understands the components of a valid order, assures this is present and scanned for all accounts. (EF)
• Reviews physician’s order for the appropriate CPT/diagnosis code to support authorization, precertification, and medical necessity according to specific payer guidelines. (EF)
• Accurately figures costs of testing/procedures for patients with or without insurance. (EF)
• Understands the process for Medical Necessity. (EF)

Emergency Room Registration Addition:

• Understands EMTALA guidelines, and relationship to job duties. (EF)
• Understands SANE, Jane/John Doe process. (EF)

Bed board Registration Addition:

• Answers phone promptly, communicates with nursing units and House Supervisors regarding needed beds and patient transfers. (EF)
• Reviews Midnight census each night for accuracy in room charges and accommodations. (EF)
• Assures order designates a status and enters patient into status based on order. (EF)
• Understands and follows the process for changing patients from one status to another. (EF)
• Documents in Bed board log appropriately.
• Follows all Bed board process as written in resource book.

Insurance Verification:

• Reviews physician’s order for the appropriate CPT/diagnosis code to support authorization, precertification, and medical necessity according to specific payer guidelines. (EF)
• Obtains insurance verification and benefits using an automated verification tool, insurance carrier websites, Patient Estimator software, or by phone. Prepares an estimate for scheduled services and notifies the patient/guarantor of any applicable out of pocket and request payment at time of pre-registration prior to service or the day of service. Accurately documents all information in the appropriate fields and/or account notes. (EF)
• Pre-registers patient cases by entering complete and accurate information into the hospital billing system prior to the patient’s arrival. Identifies and verifies all essential information pertaining to intake, guarantor, subscriber, insurance verification/eligibility, and precertification on complex and specialized patient accounts. Revises information in computer system as needed. Documenting pertinent information and efforts in the computer system with a 95% accuracy rate. (EF)
• Coordinates with patient, referring physician’s office, and/or referring location, scheduled service area, financial counselors, case management, Health Information Management, and other departments/ancillary areas as appropriate to obtain additional information or provide information on patient’s’ financial status or other potential payer technicalities.
• Maintains efficient tracking of all pending authorizations to ensure timely resolution and avoid loss of revenue and performs routine review of outstanding requests and redirects workload. (EF)
• Identifies patients at high risk for Financial Assistance and/or Management clearance, referring them to the Patient Access Manager or the Director of Patient Financial Services as warranted.

Hospital:

• Adheres to organization-wide and other applicable policies and procedures.
• Day-to-day performance complies with the hospital’s Service Excellence Behavioral Expectations.
• Performs within the prescribed limits of the hospital’s Ethics, Compliance and Confidentiality Program guidelines.
• Performs within his/her professional Scope of Practice at all times.

Other Duties As Assigned:

Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.