Patient Access Specialist - Afternoon Shift

Patient Access Representative

POSITION PURPOSE : Responsible for the complete and accurate collection of patient demographic and financial information for the purpose of establishing the patient and service specific record for claims processing and maintenance of an accurate electronic medical record. Registers and checks-in patients and determines preliminary patient and insurance liability. Performs routine account analysis and problem solving. Resolves patient account issues. Initiates billing and rebilling of accounts as appropriate. Under limited supervision; determines need for and obtains authorization for treatment / procedures and assignment of benefits required. Provides information to patients concerning regulatory requirements. At point of service, provides estimated costs and patient responsibility, facilitating collection of co-pay, deductible and private pay balances.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES :

• Obtains, verifies and enters patient identification, demographic information, and insurance coverage into hospital information system(s), to ensure accurate and timely submission of claims.
• Determines visit-specific co-payments and collects out-of-pocket liabilities.
• Assists patients with questions regarding financial liability or refer to appropriate resource(s).
• Inform patients on cost of treatment, insurance benefits, resources for payment and financial assistance. Secures and documents payment arrangements.
• Obtains medical authorization or referral forms, if appropriate. Audit authorizations for accuracy and determine if delay / deny policy needs to be invoked.
• Utilizing key reports and tools to facilitate obtaining accurate insurance information.
• Educates patients / families on the use of registration kiosks or online systems.
• Identifies non-routine complex issues and escalates to Patient Access Lead for resolution.
• Assists in the training and education of colleagues upon hire and ongoing as new systems and processes are created.
• Maintains compliance with HIPAA and other regulatory requirements throughout all activities. Protects the safety of patient information by verifying patient identity to preserve the integrity of the patient record and ensures all records are complete, accurate, and unique to one patient.
• Is proficient at the use of automated tools and makes appropriate decisions related to the relationship of the action required and the tool used. Performs pre-registration and pre-admits.
• Communicates frequently with patients / family members / guarantors, and physicians or their office staff in the deployment of key activities. Interviews patients to collect data, initiates electronic medical records, validates and enters data related to procedures, tests and diagnoses. Determines need for appropriate service authorizations (pre-certifications, third-party authorizations, referrals) and contacts physicians and Case Management / Utilization Review personnel, as needed. Obtains and verifies the accuracy and completeness of physician orders for tests and procedures, which includes name, date of birth, diagnosis, procedure, date, and physician signature to minimize risk to hospital reimbursement. Accurately uses the patient search feature to find the correct patient information and disseminates data to clinical systems for patient care. Identifies required forms or templates based on the types of services patients will receive.
• At point of service, performs insurance eligibility and determines benefit verification, utilizing EDI transactions and payer web access, and calls payers directly. Documents information within the patient accounting system through insurance eligibility / benefit verification. Refers accounts identified as self-pay to benefit advocacy resources. Conducts data search of previous accounts or payment source history, when appropriate.
• Provides financial information and patient payment options. Informs patient / guarantor of liabilities and collects appropriate patient liabilities, including co-payments, co-insurances, deductibles, deposits and outstanding balances at the point of pre-registration or point of service. Documents payments / actions in the patient accounting system and provides the patient with a patient estimate of out-of-pocket costs and a payment receipt in the collection of funds. Acquires and explains necessary documents including patient identification, insurance cards, consent for treatment, assignment of benefits, release of information, waivers, ABNs, advance directives, etc. Identifies need for patient / guarantor signature based on patient encounter / visit. Scans appropriate documents.

REQUIRED EDUCATION, EXPERIENCE AND CERTIFICATION / LICENSURE :

REQUIRED SKILLS AND ABILITIES :