Patient Access Services Representative, Full Time, 8HR Days

JOB SUMMARY :

Registers patients in a pleasant, professional, and timely manner, being sensitive to guest services. Conducts patient / guarantor interviews, explains hospital policies, financial responsibilities, and patient bill of rights.

Handles all routine patient inquiries related to the registration process. Insures all necessary demographic and financial data is obtained, and accurately documented into the system.

Identifies payor source for routing of revenue generated during the patient stay. Ensures that any pre-certification and / or authorization is obtained to meet individual payor payment authorization protocols.

EXPERIENCE / QUALIFICATIONS :

• Minimum 2 years of experience in healthcare, insurance or related experience.
• Previous work experience in an inpatient or outpatient admissions setting or physician’s office, preferred.
• Knowledge / experience in patient accounting or with an insurance payor preferred.
• Knowledge of medical terminology
• Strong interpersonal, written and oral communication skills for interacting with patients, payers, physicians and other customers.
• Demonstrated ability to work well as a team player and independently.
• Computer literacy
• Bilingual Preferred (Spanish)

EDUCATION :

• High School graduate or equivalent
• Some college and / or medical terminology coursework preferred.

LICENSURES / CERTIFICATION :

• Must successfully complete and maintain LA City Fire Card certification at the time of hire or within the first 30 days of employment
• Must successfully complete and maintain certification for Mgmt of Assaultive Behavior (ex. CPI- Non-violent Crisis Intervention) within 30 days of employment.

DUTIES AND RESPONSIBILITIES ( These are the essential job functions for this position. The essential functions of this job include, but may not be limited to those listed in this job description.

Employees hired for this position must be able to perform the essential function of this job without imposing significant risk of substantial harm to the health or safety of themselves or others) :

• Interviews and registers patients in a courteous manner and in compliance with the hospital’s policies and procedures.
• Ensures EMTALA rules and regulations are strictly adhered to when registering patients through the emergency department
• Enters required data in the system, with emphasis on accuracy of demographic data and financial information, thus ensuring appropriate revenue routing
• Validates existing data related to prior registration and updating appropriately in the system.
• Enters all patient demographic and financial information with an accuracy level of 97%.
• Scan all necessary insurance information including insurance cards, personal ID, driver’s license, etc
• Responsible for follow up on registrations performed outside of the primary registration area (ie. Conditions of Admission, Advance Directive, demographics).
• Ensures that Advance Directives are executed when applicable.
• Obtains insurance information and if applicable accident / work comp information. Verifies information, updates account and face sheets to accurately reflect patient’s insurance / coverage information and collectability of accounts.
• Identifies the appropriate payor source (plan ID, financial class, etc) and enters the information in the system.
• Ensures that all pre-certifications / authorizations are completed within the specified time frames as mandated by the payor’s payment authorization protocols.
• Ensures documentation of financial activity.
• Requests and collects deposits, deductibles, copays and payment for non-covered services to reduce bad debt expense. Provides payment options in the form of cash, check, credit card, or other bank financing where applicable.
• Utilizes tools available to ensure compliance with payor’s payment authorization protocol
• Verifies all patient insurance and confirms patient has adequate coverage.
• Completes financial packet to assess patient’s ability to pay.
• Establishes financial arrangement based on hospital’s collection policy.
• Provides the patient with summarization forms and all information explaining supplemental billing for professional fees.
• Identifies all Medi-Cal and Medicare patients through the appropriate eligibility system and through completion of the Medicare questionnaire (MSP).
• Completes the Advanced Beneficiary Notification and collects payments for services not medically necessary as stipulated by the Federal Health Care Financing Administration.
• Records comments in the system to permit timely and accurate follow up.
• Ensures patient sensitive issues are handled appropriately and timely.
• Assists admitting supervisor / director where applicable.
• Obtains proper room assignment according to the patient type and diagnosis from Admitting nurse / nursing supervisor / floor where applicable.
• Distributes face sheets or electronic data to appropriate departments in a timely manner.
• Updates census with floors for proper patient placement, where applicable.
• Refers problem accounts or accounts that need follow up to financial counselors and / or management team.
• Maintains a professional atmosphere in the hospital at all times.
• Always answers telephone in a prompt, courteous manner.
• Adjusts to changes in department schedule when reasonably requested based on census.
• Fills in for emergency situations as requested.
• Switches to a different shift other than the normal working shift when required.
• Respects patient’s right to privacy as mandated by the Patient’s Bill of Rights
• Responds to requests in a friendly, cooperative manner, as determined by feedback from guests, the supervisor and manager.
• Operates as a team with co-workers by approaching relationships in a manner which avoids antagonism and reduces conflict.
• Attends and participates in meetings and is responsible for all information communicated at meetings.
• Assists all patients, family members, physicians, visitors and employees in a professional and courteous manner.
• Assists in maintaining an atmosphere of cooperation with other departments and allied professionals.
• Demonstrates the ability to participate in and / or implement team decisions.
• Actively participates in and encourages actions that promote good public relations with patient’s families, visitors, and the community.
• Shares information on a need to know basis, adhering to all HIPAA standards.
• All other job duties as assigned.

The following job accountabilities are not unique to this particular job but are common to all jobs at VPH :

Complies with VPH policies and procedures on customer satisfaction and service excellence. Demonstrates professionalism and cultural sensitivity in coordinating activities and communicating with all customers, peers, and the community at large.

Conducts self in a professional, respectful and courteous manner during all interactions. Works effectively and collaboratively with others toward common goals.

Communicates accurately, honestly, and in a timely manner with department and interdepartmental team members. Demonstrates effective business writing and oral communication skills, handwriting is clear and legible.

Participates in operational aspects of the department, and maintains / participates in performance improvement activities within the department.

Participates in all departmental specific training, Environment of Care (injury / illness prevention, fire / life safety, hazardous materials, emergency preparedness, utilities management, medical equipment management, safety and security management), infection control (standard precautions, TB Exposure Control Plan, Bloodborne Pathogen Exposure Control Plan).

Demonstrates knowledge of and follows safety practices. Understands the importance of safety, including patient safety in the work place.

Maintains a safe environment for self and others.

Actively participates in the Patient Safety Program, including event reporting. Identifies sentinel events / near misses and responds per defined organization processes.

Participates in education activities and process implementation. Demonstrates advocacy for the patient / customer and appropriately acknowledges patients, customers and visitors.

The above statements reflect the essential functions considered necessary to describe the principle content of the job. They are not intended to be a complete statement of all work requirements or duties that may be inherent in the job.

WORK ENVIRONMENT :

• Primarily an inside building / office environment, well lighted and ventilated, which may consist of multiple treatment and / or work sites.
• Fast and continuous work pace with variable workload.
• Frequent contact with staff and public under a variety of circumstances. Requires ability to communicate clearly (in English) verbally and in writing for effective communication with other staff members, physicians, vendors, community members, patients and patient families, employees and applicants of all socio-economic levels from a diverse cultural and ethnic population.
• Subject to many interruptions from multiple calls and inquiries.
• Potentially exposed to emotional situations involving accidents, injuries, illness and / or death.
• Handles emergency / crisis situations in accordance with Hospital policy.
• Answers phones or pages; may carry a beeper / pager, and / or use a two-way radio.
• Potential risk of exposure to hazards from chemicals (toxic and non-toxic), flammable materials, gas or electrical or radiant energy or equipment with / without moving parts.

PHYSICAL DEMANDS :

Key for Physical Demands

Continuous

66 to 100% of the time

Frequent

33 to 65% of the time

Occasional

0 to 32% of the time

Clerical / Administrative Patient Care

• Frequent sitting and standing / walking with frequent position change.
• Continuous use of bilateral upper extremities in fine motor activities requiring fingering, grasping, and forward reaching between waist and chest level.
• Occasional / intermittent reaching at or above shoulder level.
• Occasional / intermittent bending, squatting, kneeling, pushing / pulling, twisting, and climbing.
• Occasional / intermittent lifting and carrying objects / equipment weighing up to 25 pounds.
• Continuous use of near vision, hearing and verbal communication skills in handling telephone calls, interacting with customers and co-workers and performing job duties.

Salary Range : $19.47 - $24.12 per hour

PATIENT POPULATION SERVED (if applicable, this position is responsible for age-related physiological, emotional and cognitive needs of the following age groups of patients) :

Newborn

Pediatric

Adolescent

Adult

Geriatric