Patient Access Representative (Nights)

Statement Of Employment Philosophy

Being a part of Tanner Health System is more than a job, it is a promise we make to treat every patient with exceptional service every time they walk through our doors. Service excellence is the foundation of our organizational culture and the expectations we all set for each other, our patients, physicians and our community. All employees agree to abide by a set of service standards. These standards are the promise we make to provide the best care possible, and represent our beliefs, values and who we strive to become. We each commit to making Tanner Health System a great place for our employees to work, for patients to receive care and for physicians to practice medicine.

Functions

Area of Responsibilities

• Registration Quality - Registers patients following department's standards, policies and procedures, focused on consistently efficient throughput and the overall patient experience

• Registration Quality - Enters required patient data in the system, with emphasis on accuracy of demographic data and financial information, thus ensuring appropriate revenue classification, routing & reimbursement. Reviews all quality edits, exceptions or rejections via registration quality or billing software to reduce or address denials.

• Verification Quality - Validates all insurance through the appropriate eligibility system and ensures COB (Coordination of Benefits) validation via the payor response or Medicare Secondary Payor Questionnaire (MSPQ) where applicable. Ensures managed care payors are entered correctly in the HIS, per the eligibility response.

• Verification Quality - Reviews data entry to ensure all payor mnemonics utilized, match electronic or phone eligibility obtained to include COB, managed care, coverage types (HMO, PPO, POS, CMO, IP Only, liability etc).

• Verification Quality - Ensures that all pre-certifications authorizations, matching planned services, are completed or updated, within the specified time frames as mandated by the payor's payment authorization protocols and thoroughly documented on the account. Performs medical necessity check, utilizing accurate payor guidelines and facilitates additional diagnosis order requests where relevant.

• Verification Quality -If in a supporting role (ie IP verification, Surgical Verification etc), validates existing payor data from prior registration or pre-registration entry and makes updates revisions appropriately in the account, to ensure a clean claim

• Documentation Quality - Ensures all registration related signature capture is completed to include consents, regulatory documents, etc.

• Documentation Quality - Ensures all relevant payment liability forms are completed consistently & compliantly, to include Medicare Advanced Beneficiary Notices, Medicaid Advanced Beneficiary Notices, Waiver of Liability forms etc. Further ensures these forms are delivered before services are rendered, with focus on the patient experience.

• Documentation Quality -Enters data & comments in the designated HIS fields, to permit timely and accurate follow up, ensuring documentation of financial activity, clearance, special circumstances etc.

• Documentation Quality - Timely and accurately scans all necessary insurance information including insurance cards, personal ID, driver's license, eligibility & authorization validation, etc. Assist with timely order inventory processing by consistently indexing orders from order management system.

• Patient Estimation & Collection - Creates patient estimates based on scheduled or walk in services, using Epic Estimates workflow. Reviews populated data for errors related to location pricing info, coupled with the eligibility responses ie missing benefit info. Reviews developed estimates with patients, to ensure understanding and captures e-signature.

• Patient Estimation and Collection - Always requests payment of patient liabilities based on estimate or eligibility response, utilizing departmental standard scripting, to overcome patient payment obstacles. Applies discounts according to department standard.

• Performs the cashier function for all patients registered and for those that present for account payment of services, when a centralized cashier is unavailable. Completes individual or departmental deposits as directed.

• Productivity - Consistently focuses on maximizing resources and time, to ensure expeditious patient throughput and account processing. Proactively solicits peers and leaders, offering assistance to avoid non-productive or downtime periods.

• Productivity - Remains flexible to provide float support for all PAS operational areas as requested by leadership, through schedule changes and assignments.

• Assist patients with medical records requests where assigned by leader

• Partners with case management and or nursing services to ensure accurate patient placement and status, aligned with physician order.

• Process Improvement - Exhibits a culture of operational excellence through personal ownership in individual and departmental process efficiency, quality and outcomes.

• Maintains a working knowledge of department and facility policies and procedures. Displays independent reasoning skills for problem resolution as required within the scope of job assignments.

• Demonstrates a positive attitude toward all THS customers and projects a positive professional image.

• Maintains proficiency of technical skills in all areas of your primary assigned department as necessary to assume duties of call rotation as required.

• Maintains confidentiality of all patient data and medical information. This includes refraining from accessing your own personal medical record or the medical record of another individual, where you were not actively working the encounter for scheduling, registration, authorization etc. Any instance of this is considered a HIPAA violation.

• Distinguishes and responds correctly to certain disaster or emergency situations such as fire alarm, visitor injury, etc.

• Performs other tasks as assigned.

Compliance Statement

• Employee performs within the prescribed limits of Tanner Health System's Ethics and Compliance program. Is responsible to detect, observe, and report compliance variances to their immediate supervisor, the Compliance Officer, or the Hotline.

Required Knowledge & Skills

Education: High School Diploma or GED

Experience: No prior work experience required

Licenses and Certifications

• NONE REQUIRED

Supervision

• None

Qualifications

• Excellent public relations skills. Pleasant professional demeanor when dealing with the public even irate or abusive individuals. Must possess the ability to communicate effectively and maintain good relations with co-workers, the hospital and medical staff as well as with patients, families, and third party payers.

• Ability to make independent decisions, displaying emotional maturity and using sound judgment.

• One year previous customer Service experience preferred. Previous experience or knowledge of ICD-9, CPT-4 coding techniques preferred. Knowledge of medical terminology preferred. Relevant training or education may be considered as experience.

• Ability to interact and work well as a part of a team oriented environment.

• Ability to comprehend and apply a large variety of operating procedures.

• Ability to organize for maximum time utilization, productivity and smooth patient flow.

• Ability to work effectively in high stress situations. Ability to work in fast-paced environment with frequent interruptions.

• Proficient use of computer equipment.

• Ability to read and write legibly with spelling accuracy.

• Exhibit flexibility through availability to work hours and days, potentially outside of normal ".shifts". or routines, as needed, based on departmental or system demands.

• Some college coursework preferred

Definitions

Facilitates quality and efficient patient intake process through pre-registration, registration, insurance and precertification verification, document completion, POS collections and work output review. Work assignment will include multiple locations within the facility or system, performing various tasks within PAS operations, to include call center, patient facing and bedside functionality.

Position Responsibilities

Contact with Others: Appreciable contacts as regular part of the job with others outside of the department or organization. Requires discretion and tact to give or get specialized information to perform duties of job.

Effect of Error: Probable errors may be serious and involve losses such as improper costs, overpayment, waste of material, damage to equipment, and delay in processing work. Effect usually confined within the organization. Most of work not subject to direct verification or check. Regularly works with some confidential data such as account, salaries, patient medical records, which if disclosed might have adverse internal or external effects.

People Management Responsibilities

Supervisory Responsibility: Exercises no supervision, work direction, or instruction of other employees or students

Work Environment/Physical Effort

Mental Demands: Work involves a variety of problems in a general field, some of which are complex. Involves some independent judgment to decide what to do to assemble facts, determine variations from standard procedures, or plan other action to be taken to meet general objectives.

Working Conditions: Noticeable - (About 25% of the day) Involved in exposure to dirt, odors, noise, or some work is performed with exposure to temperature/weather extremes/occupational risk and probability of coming into contact with blood borne pathogens, other potentially infectious diseases, or biomedical/bio-hazardous materials.

Working Conditions Aspects for Immunizations

Performs tasks involving contact with blood, blood-contaminated body fluids, other body fluids, or sharps (needles): No

Directly works with Patients less than 12 months of age: No

Physical Effort: Minor physical effort - Job requires person to stand and/or walk frequently. Lifts, carries, or uses lightweight (1 to 25 lbs.) materials or equipment less than half of the day. Works in reaching or strained position intermittently. Office or laboratory work requires close visual effort less than half of day. Office or Laboratory work with concentration on a monotonous, repetitious procedure or skill most of day, where speed and accuracy are essential.

Physical Aspects

Bending: Occasional = 1% - 33% of the time

Typing: Constant = 67% - 100% of the time.

Manual Dexterity - picking, pinching with fingers etc.: Frequent = 34% - 66% of the time

Feeling (Touch) - determining temperature, texture, by touching: Not required

Hearing: Constant = 67% - 100% of the time.

Reaching - above shoulder: Occasional = 1% - 33% of the time

Reaching - below shoulder: Occasional = 1% - 33% of the time

Visual: Constant = 67% - 100% of the time.

Color Vision: Occasional = 1% - 33% of the time

Speaking: Constant = 67% - 100% of the time.

Standing: Constant = 67% - 100% of the time.

Balancing: Occasional = 1% - 33% of the time

Walking: Constant = 67% - 100% of the time.

Crawling: Not required

Running - in response to an emergency: Not required

Lifting up to 25 lbs.: Occasional = 1% - 33% of the time

Lifting 25 to 60 lbs.: Not required

Lifting over 60 lbs.: Not required

Handling - seizing, holding, grasping: Frequent = 34% - 66% of the time

Carrying: Occasional = 1% - 33% of the time

Climbing: Not required

Kneeling: Occasional = 1% - 33% of the time

Squatting: Occasional = 1% - 33% of the time

Tasting: Not required

Smelling: Not required

Driving - Utility vehicles such as golf carts, Gators, ATV, riding lawnmowers, skid steer, aerial lift: Not required

Driving - Class C vehicles: Not required

Driving - CDL class vehicles: Not required

N95 Respirator usage (PPE): Occasional = 1% - 33% of the time

Hazmat suit usage (PPE): Occasional = 1% - 33% of the time

Pushing/Pulling - up to 25 lbs.: Constant = 67% - 100% of the time.

Pushing/Pulling - 25 to 60 lbs.: Not required

Pushing/Pulling - over 60 lbs. : Not required