Job Details

Patient Access Representative PRN

The Patient Access Representative is responsible for the complete and accurate registration of all patients obtaining services at the facility. Responsible for accurately gathering and entering patient information into the computer as received from the patient and/or the physician's office, verifying benefits for non pre-registered patients, and obtaining signatures on required forms. Responsible for collecting co-payments, deductibles, and co-insurance from patients at the time of service. Responsible for ensuring an efficient, complete, and timely patient registration process that models the customer service philosophy of the facility.

Essential Functions:

• Communicate with clinical departments or Scheduling Representative to obtain scheduled appointments and/or orders prior to the service date.
• Pre-register 98% of all scheduled patients a minimum of three (3) business days in advance of their arrival.
• Obtain, validate and accurately enter in the computer system, the patient's demographic and insurance information while maintaining an acceptable accuracy rate (95% plus) as evidenced by routine quality review. Information may be obtained from the physician's office or the patient via direct contact, telephone or fax.
• Thoroughly review the MPI so that duplicate medical records numbers are avoided.
• Obtain signatures on all necessary forms and documents required by hospital and by law.
• Ensure MSP Questionnaire is completed for every Medicare registration.
• Work closely and cooperatively with the physician office staff, schedulers and other hospital departments to schedule and prepare required information before the patient's arrival.
• Utilize online programs to verify insurance eligibility and benefits, documenting findings on the patient account. Assist by contacting to the insurance company for pre-authorizations and pre-certifications as required prior to patient receiving service when asked by Director.
• Effectively communicate with physician office staff to resolve authorization issues and coordinate registrations as required.
• Collect co-payment, deductible or co-insurance previously identified by the Insurance Verification Specialist or as indicated on the insurance card or online eligibility system, when the patient arrives for service.
• If working in Emergency registration, ensures compliance with the EMTALA regulation for all patients.
• Log cash collected, generate receipts, and maintain balanced cash at all times.
• Meet monthly cash collection goals as determined collaboratively by Department Director/Manager and CBO.
• Consistently obtain and copy/scan insurance cards and driver licenses.
• Responsible for knowing the functions of the phone system in order to professionally handle incoming calls, appropriately transfer calls, and assist with any internal calls when asked to do so by Department Director or Team Lead.
• Perform the reception/greeter function at the front desk entrance as needed.
• Verify medical licensure and check Medicare Sanctions websites for non-credentialed physicians ordering outpatient diagnostic tests (Community Hospital Only).
• Consistently demonstrate premier customer service and communication skills with all internal and external customers/contacts and ensure the patient and their family members have the best hospital encounter possible.
• Meet established quality and productivity standards for self and for the team.
• Anticipate and adapt to change (e.g., hospital policy changes, operational/procedures, insurance changes) in a positive manner.
• Foster and reinforce team-based results.
• Adhere to time and attendance standards as outlined in the Human Resource Policy manual. Provide proper notification of absence or tardiness within established departmental time frames.
• Ensure patient confidentiality adhering to HIPAA guidelines.
• Demonstrate the knowledge, skills and abilities (competencies) to perform the duties outlined above annually in the form of a test or as evidenced by daily quality review and direct observation of the Team Lead and the Department Director/Manager.
• Track and monitor productivity as requested.
• Keep Department Director or Team Lead apprised of any delays in the registration process.
• Remain current on scheduling, registration, insurance verification, and other patient registration processes in order to cover in the absence of other team members.
• Perform other duties as assigned.

Accountability:

• Reports to: Director or Manager, Team Leader, Patient Access
• Supervises: None

Qualifications:

• High School graduate or equivalent required; 2 years college preferred.
• Experience in patient registration, verification and authorization in a medical center or comparable institution demonstrating the skill, knowledge and ability to perform registration duties preferred.
• Working knowledge of governmental regulations and other reimbursement criteria preferred.
• Ability to accurately type 40 WPM, complete forms, simple correspondence, handle payment transactions and enter data.
• Excellent verbal and written communication as well as interpersonal skills required.
• Demonstrated ability to handle multiple tasks with short time-lines, prioritize and organize work, and complete assignments in a timely and accurate manner.
• Exceptional ability to interact and communicate effectively, tactfully, and diplomatically with patients, families, medical staff, co-workers, employers and insurance company representatives.
• Must have a pleasant disposition, positive attitude and possess the ability to maintain a cordial and professional approach during periods of stress.
• Skill in using office equipment: basic computer skills, photocopier, telephone, fax machine, and calculator.
• Demonstrated ability to think and act decisively in a timely manner.
• Ability to maintain operational knowledge of all insurance requirements necessary to achieve optimal reimbursement.

Required Physical Demands:

• Strength (Lift, Carry, Push, Pull): Sedentary; exerting up to 10 pounds of force occasionally
• Standing/Walking: Occasionally; activity exists up to 1/3 of the time
• Keyboard/Dexterity: Frequently; activity exists from 1/3 to 2/3 of the time
• Talking (Must be able to effectively communicate verbally): Yes
• Seeing: Yes
• Hearing: Yes
• Color Acuity: No

Environmental Conditions:

High exposure to hazardous risks including potential for exposure to infections and communicable diseases, blood and body fluids, electrical equipment and chemicals, and must follow standard precautions. Heavy work volume and high degree of accuracy required. May be required to work weekends or flex schedules. May be required to travel, and during travel, may be exposed to inclement weather conditions.