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Lead Patient Access Rep

Lead Patient Access Rep

Driscoll Children's HospitalCorpus Christi, TX, US
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Where Compassion Meets Innovation and Technology

Thank you for your interest in joining our team! Please review the job information below.

General Purpose of Job :

This position reports to the Patient Access Service Director, through the Manager. This position is responsible for the support of the team functions necessary to accomplishing the objective of the service department. These include, but are not limited to functions under the categories of : patient accounting, patient scheduling & registration, verification of patients' benefits, securing reimbursement via prior authorization / referrals or time of service collection, documentation of actions taken to collect out of pocket expenses and patient financial discharge.

Essential Duties and Responsibilities :

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and / or hospital administration as required.

  • Maintains utmost level of confidentiality at all times.
  • Adheres to hospital policies and procedures.
  • Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
  • Adheres and complies with customer service standards and dress code as set forth by the hospital and the department.

Customer Service Duties

  • Answers the department telephone immediately or within three rings utilizing courtesy and patience
  • Greets patients and their families with courtesy and concern for their needs
  • Listens to customer needs and takes appropriate action as indicated
  • Gathers patient demographic and financial information in a kind and courteous manner.
  • Reschedules patients upon patient request and notifies the patient's physician.
  • Marks patient cancellations in the appropriate scheduling system and notifies the patient's physician.
  • Documents telephone encounters.
  • Manages an appointment waiting list as indicated.
  • Calls patients to confirm appointment times and offers any other pertinent information such as out of pocket expense, education, directions, parking information, etc.
  • Patient Accounting Duties

  • Schedules patients for necessary procedures as indicated, using the appropriate scheduling system and obtains authorization for all planned services as indicated by insurance carrier.
  • Accurately creates patient encounter in patient accounting systems utilizing the appropriate patient search criteria and interview method.
  • Verifies patient's insurance benefit and documents findings, this process should be completed in the appropriate timeframe for the service being provided; refer to EMTALA guidelines.
  • Refers cases for financial screening as indicated.
  • Obtains Authorization or Referral for services as indicated.
  • Makes a clear copy of picture identification and insurance cards, front and back.
  • Explains all business forms and obtains signatures.
  • Issues Patient Rights and Responsibilities and the hospitals Notice of Privacy Practice as indicated.
  • Issues patient identification card or wristband identification as appropriate.
  • Escors the patient to the appropriate service area.
  • Quality Assurance Duties

  • Reviews schedule / pre-registrations / registrations to identify potential duplicate medical record numbers.
  • Identifies patients with multiple same day visits to match demographic and insurance data for each pre-registration.
  • Reviews patient demographic and financial data to ensure accuracy.
  • Validates verification and documentation of insurance eligibility and coverage for anticipated procedures.
  • Validates insurance authorizations was obtained from referring physicians when necessary / appropriate.
  • Validates insurance authorizations was obtained from payors when necessary / appropriate.
  • Validates documentation of patient insurance benefit, co-payment, deductible and co-insurance agreements in preparation for collection at the time of service or prior to discharge.
  • Closes recurring accounts as indicated.
  • Reviews pre-registration list for no shows and cancellations to reschedule or cancel account as indicated.
  • Reconcile Census with Census Reports and Registration forms as indicated.
  • Patient Financial Discharge Duties

  • Reviews documented notes for payment requirements; explains insurance benefits as quoted to us by their insurance carrier, and collects patient's out of pocket expenses
  • Refers cases for financial screening as indicated.
  • Prepares hospital receipt for payment received.
  • Validates address and phone number.
  • Ensures all paperwork is complete and all insurance cards and identification cards are copied for business record.
  • Documents all actions taken at discharge in patient accounting system.
  • Cashiering Duties

  • Cash box will be in balance at all times.
  • Payments received will be receipted and accounted for at all times.
  • The department Standard Operating Procedure for cash handling will be followed.
  • Lead Role

  • Coordinates shift staffing
  • Coordinates workflow
  • Ensures the financial discharge process is being followed by the entire team
  • Ensures customer needs both internal and external are being exceeded and issues addressed to the satisfaction of the customer
  • Performs team and shift change debriefs for the purpose of communicating important information and performance measures in a consistent manner as directed.
  • Education and / or Experience :

  • High school diploma or general education degree (GED); or six months related experience and / or training; or equivalent combination of education and experience.
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    Patient Rep • Corpus Christi, TX, US

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