Job Details
PATIENT ACCESS REP
1st SHIFT
24 HOURS/Rotating Weekends/Holidays
Benefits!
JOB SUMMARY:
Under the direction of the Patient Access Manager, the Patient Access Representative is responsible for obtaining and verifying patient demographic information, insurance, and other information for various hospital records. Informs patient of hospital and regulatory policies in regards to patient care and collection practices. Functions as the communication liaison of patient services, as appropriate from Pre-cert to Admission.
ESSENTIAL RESPONSIBILITIES:
- Responsible for front-end revenue cycle management by registration of patients for Emergency, Scheduled Outpatient and Inpatient procedures.
- Requires extensive knowledge of all insurances and demographic information which drives the revenue cycle.
- Responsible for switchboard operations including emergency operations procedures.
- Greets patients, relatives or patient representatives as the communication liaison for patient services and access.
- Responsible for current and new regulatory requirements for state, federal, and commercial payors.
- Responsible for ABN and co-payment collection practices.
- Follows-up on incomplete registrations by contacting physician offices or patient at-home to get complete information.
- Receives inquiries from other facilities regarding patient demographic and insurance information.
SKILLS & ABILITIES:
- Ability to maintain confidentiality concerning patient problems and hospital matters.
- Ability to deal with the public in a courteous, efficient and empathetic manner.
- Ability to plan, organize and direct flow of communications and tasks within job description and responsibility.
- Ability to work calmly and effectively under stressful conditions.
- Ability to concentrate on detailed and repetitive record keeping.
- Ability to type 35 WPM.
- Ability to work effectively with other members of the team.
PHYSICAL DEMANDS:
- Requires walking and sitting to a significant degree. Exerting up to 50 pounds of force in order to push a bariatric wheel chair and entails pushing and pulling occasionally (occasionally: activity or condition exists up to one third of the time).
ENVIRONMENTAL CONDITIONS:
- Inside: Protection from weather conditions but not necessarily from temperature changes. A job is considered "inside" if the worker spends approximately 75 percent or more of the time inside. May be exposed to communicable diseases, distraught behavior, high-noise level, varied degrees of activity and hazardous chemicals.
REASONING, MATHEMATICAL AND LANGUAGE DEVELOPMENT:
- Reasoning - Must apply principles of rational systems to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Apply common sense understanding to carry out instructions furnished in written, oral, or diagrammatic form.
- Math - Add, subtract, multiply and divide all units of measure. Performs the four operations with decimals and fractions. Computes ratio and proportions, rate and percent. Draws and interprets bar graphs. Performs computations involving all American monetary units.
- Reading - Ability to read instructions, manuals, and memos.
- Writing - Ability to write sentences, using cursive-style, proper punctuation and employing adjectives and adverbs.
- Speaking - Ability to speak clearly and distinctly with appropriate pauses and emphasis, correct pronunciation, variations in word order, using present, perfect and future tenses.
RELATIONSHIPS TO DATA, PEOPLE AND THINGS:
- Data - Compiling, gathering, collating or classifying information about data, people or things. Reporting and/or carrying out a prescribed action in relation to information is frequently involved.
- People Speaking Signaling: Talking with and/or signaling people to convey or exchange information. Serving: Attending to the needs, requests or the expressed or implicit wishes of people. Immediate response is involved.
- Things - Tending, starting, stopping, and observing the functioning of machines and equipment. Involves adjusting materials or controls of the machine, such as changing guides, adjusting timers and temperature gauges, turning valves to allow flow of material, and flipping switches in response to lights. Little judgment is involved in making these adjustments.
QUALIFICATIONS:
- Education: High school graduate or equivalent required.
- Experience: 2 years Customer Service experience preferred.
- Knowledge of Healthcare Insurance preferred
- Knowledge of medical terminology preferred.
- Excellent customer service skills required.
- Computer literacy required.
JOB DUTIES/RESPONSIBILITIES:
Although position has no responsibility for the assessment, treatment or care of patients, demonstrates ability to communicate and interact with patients and customers of all ages.
Demonstrates knowledge of all department and hospital policies relevant to the performance of their responsibilities.
Demonstrates knowledge and application of principles of fire safety, infection control, hazardous communication program, universal precautions and general safety.
Directs patients to triage for urgent and emergent services; assists patients with transportation (wheelchairs) when needed and notifies the Medical staff when patients arrive for triage.
Determines if the call to triage should be a STAT call to ensure that the emergency room patients are seen according to severity of symptoms
Interviews patient and/or patient's representative to obtain required information to complete the registration process in the DKH HIS system. This requires a minimum of 23 fields for each person in
the demographic screens (patient contact person, guarantor) and 29 data fields for the account Verifies insurance benefits to insure the appropriate pay source is obtained.
Extensive knowledge of all insurance, Medicare, Medicaid, and commercial payors, including demographic information which drives the revenue cycle.
Coordinates all registrations; pre-registrations, admissions and pre-admissions activities with medical staff, physician offices, patient accounts and all other hospital departments as required to support the operation of all hospital systems.
Understanding and processing of Advanced Beneficiary Notice (ABN) at registration including the ability to explain the ABN to the patient and obtain the required signature.
Responsible for informing patient or patient representative of the "Important Message from Medicare" form and obtain the required signature
Completes the Medicare questionnaire for each registration.
Scans insurance cards and photo identification into the system.
Ability to recognize identity fraud and notify the appropriate staff.
Daily bed reporting to the State of CT Bio T prep emergency management system.
Verifying all patients that in are in-house via the midnight census for statistics.
Releasing bodies from the morgue.
Notification of inpatient admissions over the weekend to insurance companies that require notification
in less than 24 hours.
Accepts and processes payments for patients as necessary. Provides receipts for payments received.
Knowledge of CPT and ICD9 codes for Advance Beneficiary Notice Software.
Knowledge of CPT and ICD9 codes for Pre-cert duties.
Discuss past due balances with patients and attempts to collect.
Scrubs accounts for accuracy to deliver clean claims on the back end.
Calculates prompt pay discounts for co-pay collections.
Prints all forms for patient's chart and send to appropriate area.
Operates office machines, such as computer terminal, computer mouse, adding machine, printer, and fax.
Maintain confidentiality at all times and in all situations.
Answers all incoming calls and transfers to appropriate person/department in a timely courteous manner.
Remains knowledgeable and up to date on all emergency and general functions of the console operation.
Maintains a thorough knowledge of departmental polices and procedures to ensure maximum reimbursement to the hospital.
Maintains professional and cooperative relations with fellow employees, medical staff, physician office staff, patients and guests to ensure superior customer service.
Attends departmental and other meetings as requested by the immediate supervisor.
Demonstrates competency in utilizing resources to accommodate cultural needs of patients and customers such as dietary, religious and language needs.
Performs other work-related duties and activities as assigned or requested
Demonstrates efforts to maintain and improve job specific competencies. Incorporates new knowledge into practice.
Participates in performance improvement activities.
Remains flexible in work schedule in order to provide the most effective and efficient support for the department and hospital mission.
Performs other duties as assigned.