Patient Service Representative I (Admitting Representative) (Full-time - Day / Eve)

Patient Access Representative

Hours : 40 hours per week - Monday through Friday from 10 : 30 AM to 7 : 00 PM.

Location : Onsite at Tufts Medical Center in Boston

Requirements : 2 weeks of full time training during the day shift is required.

Job Profile Summary : This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In addition, this role focuses on performing the following Patient Access duties : Performs the administrative and financial-clearance duties necessary to facilitate the procurement of clinical services by patients. Collects patient's necessary demographic and financial information from physician offices, acute-care entities, or the patients themselves, schedules services for patients, and handles referrals from primary care doctors to ensure patients are scheduled for recommended appointments / procedures, etc. An organizational related support or service (administrative or clerical) role or a role that focuses on support of daily business activities (e.g., technical, clinical, non-clinical) operating in a "hands on" environment. The majority of time is spent in the delivery of support services or activities, typically under supervision. An entry level role that typically requires little to no prior knowledge or experience, work is routine or follows standard procedures, work is closely supervised and communicates information that requires little explanation or interpretation.

Job Overview : This position is responsible for interviewing inpatients and outpatients with a courteous and professional demeanor to obtain accurate and complete patient registration data. Responsible for collecting and documenting in hospital registration system demographic and financial information for scheduled visits and completing pre-service collection of patient liability (including, but not limited to deductibles, coinsurances, co-payments, etc.) and / or bad debt. This position is also responsible for verifying patient insurance, confirming benefits eligibility, performing pre-authorization, pre-certification, and / or notification as required by third party providers.

Job Description :

Minimum Qualifications :

1. High school diploma or equivalent.

Preferred Qualifications :

1. One (1) year of experience in customer service setting, hospital registration, medical office, insurance, etc.

Duties and Responsibilities : The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list. Other duties and responsibilities may be assigned.

• Conducts Pre-Registration tasks for specified inpatients and outpatients prior to their date of service including : collects demographic, financial, and clinical information necessary for financial clearance of scheduled patients; obtains missing insurance information via patient's family or physician offices; and completes insurance verification using online electronic verification system or contacting payor directly.
• Obtains consent for treatments and authorizations as necessary. Explains signature requirements to patients and patient's representatives in a manner that is easily understood by the patient or their representative.
• Verifies the validity of insurance coverage via eligibility tools. Ensures the appropriate plan codes have been added to registration based on the information provided in the eligibility response. Educated on different insurance plans and coordination of benefits. Able to identify if there are any concerns with coverage after checking insurance eligibility.
• Collects the appropriate information for auto and worker's compensation registrations including information collected from the responsible party including the auto or worker's compensation carrier, agent and / or employer. If full information is not collected, notes are properly documented as to why the information was not collected or available.
• Notifies patient of financial liabilities as determined by insurance benefits, coverage limits, and appointment / procedure-specific charges.
• Takes an active role in the collection of patient payments. Understands all collection policies and procedures that pertain to time-of-service collections. Communicates these policies effectively to patients following prescribed scripting. Understands the use of credit card devices regarding payments and credits. Is aware of all types of credit cards accepted by the organization.
• Posts collected payments in system of record and verify appropriate dollar amount and volume are posted in compliance with department guidelines.
• Provides Financial Counselor contact information to patients qualifying for state-sponsored financial assistance. Documents patient's financial state and related information in system of record for reference of hospital administration and billing.
• Obtains authorization, pre-certification, referral, and / or notification as necessary. Attaches verification to patient's account and documents information in the system of record for reference of hospital administration and billing.
• Takes personal responsibility to provide excellent customer service and delivers exceptional professional courtesy to all patients.
• Interacts with physicians, nursing units, and office staff in a courteous and professional manner.
• Maintains hospital financial information confidentially in accordance with all hospital policy and any state or federal regulations such as the HIPAA Privacy & Security Standards.
• Meets the requirements of area specific benchmarks related to productivity and customer service such as wait times, call monitoring score card scores, number of registrations or calls processed, etc.

Physical Requirements :

Skills & Abilities :