Under general supervision, coordinates and performs multiple complex functions within the Patient Access department. Utilizes judgment to interpret department policies to resolve routine to complex inquiries / patient account problems with other departments.
Identifies opportunities for process improvements and offers potential solutions.
Participates in meetings as a representative of the department. Serves as a resource to team members for training, problem resolution, etc.
Performs all duties in a manner that promotes a team concept and reflects the mission, behaviors, core values and philosophy of CT Children's Medical Center.
Administrative :
- Following department protocol provides general receptionist, secretarial support, or Health Unit Coordinator functions.
- Performs a variety of administrative support activities in support of the unit operations.
- Responds with tact and discretion to the needs of patients and families.
- Maintains privacy and confidentiality.
- Assists with staffing assignments and scheduling as requested.
Registration :
- Collects and enters accurate demographic, guarantor and financial data for Emergency Department, Inpatient and Outpatient cases and Physician Practice Office appointments.
- Verifies all required insurance and billing information and uses the proper payer plan codes.
- Generates all necessary forms for patient visit and obtains patient / parent / legal guardian signature for Assignment / Authorization and consent.
- Performs pre-registration for scheduled patients and registers patients upon arrival adhering to standard department procedure.
- Makes corrections and updates patient information in computer systems as necessary.
- Asks patients / families whether their visit was satisfactory and attempts to address any questions / issues prior to patient departure.
- Documents thorough, clear, explanatory notes regarding reasons for incomplete information at time of registration. Documents concise and understandable comments regarding patient or guarantor interaction, efforts to collect co-payments and referrals to Financial Assistance.
- Follows-up on open items to resolve outstanding issues and complete the file.
- Reviews all documentation records regarding incomplete information at time of registration, patient or guarantor interaction, efforts to collect co-payments, estimated self-pay balances and referrals to Financial Assistance.
- Follows up with team member responsible for resolving the open issue to provide assistance or additional training to ensure prompt completion of the file.
- Reviews and works assigned work queues for registration information to ensure that accounts are accurate at time of visit and or billing.
Scheduling :
- Schedule complex appointments either in person or via telephone
- Creates / inputs complex department provider appointments.
- May schedule / coordinate appointments with other areas of the hospital.
- As a first line representative of CT Children's, this person must have the ability to deal compassionately and professionally with patients and families.
Front Office (Check-In) :
- Arrives patients for their appointment in the ADT system.
- Verifies demographic and insurance information at time of arrival (including securing patient financial liability at time of service).
- Check out process including scheduling or rescheduling future appointments.
- Answer telephone and triage calls for the department.
- Ensure all consent and privacy forms are signed.
- Work directly with DCF to obtain appropriate signatures / legal guardian information.
- Enters routine to complex patient charges into billing system for physician or care provider visits, according to protocol.
- Other front office duties as required.
Financial Clearance :
- Responsible for various work queues of scheduled and / or non-scheduled appointments.
- Communicates with insurance companies to obtain benefits, referrals, and / or authorization requirements.
- Communicates with Clinical / Office staff of patient eligibility, authorization status, and need for clinical documentation.
- Completes chart reviews to submit all appropriate documentation to insurance companies for authorization purposes.
- Coordinates with third party payers regarding information necessary for appropriate financial processing of patients, including : follow-ups with primary care providers for referrals and authorizations;
notifying insurance carriers of admissions; obtaining authorizations and verifying benefits eligibility.
- Refers patients / families to Financial Counseling for updated and / or eligibility issues.
- Works directly with RN, APRN, and MD level staff to notify of denials requiring further action.
- Coordinates with Utilization Review for status designation of Outpatient / Inpatient Admissions.
Financial Counselor :
- Interviews patients to verify complete insurance and financial information, explain financial policies, complete appropriate financial evaluation forms.
- Refers patients / families to DSS and Financial Assistance.
- Determines guarantor's propensity to pay non-covered charges, as well as determine potential eligibility for financial assistance programs.
- Establishes financial arrangements / payment plans with patients.
- Identifies reason(s) for non-payment and follows-up to ensure resolution.
Financial Responsibility :
- Verifies insurance plans using the various methods available such as RTE, Web-Based, & Telecommunications.
- Investigates patient insurance coverage, facilitates certification, manages process to maximize payment from both commercial and managed care plans.
- Follows-up with team member responsible for patient account to resolve outstanding financial issues.
- Demonstrates knowledge of the age-related differences and needs of patients in appropriate, specific populations from neonate through adolescence and applies them to practice.
- Demonstrates cultural sensitivity in all interactions with patients / families. Demonstrates support for the mission, values and goals of the organization through behaviors that are consistent with the CT Children's STANDARDS
Education and / or Experience Required :
- High School Diploma, GED, or a higher level of education that would require the completion of high school, is required.
- 5-7 years directly related experience preferred; Healthcare experience required.
Education and / or Experience Preferred :
Associates Degree preferred.
License and / or Certification Required :
CHAA (Certified Healthcare Access Associate) obtained within 1 yr.
Knowledge, Skills and Abilities :
Knowledge of :
- Intermediate knowledge of MS Word and Excel.
- ADT systems and Insurance Verification systems (EPIC preferred).
- Knowledge of Managed Care, referral / pre-certification / authorization process.
- HIPAA.
Skills :
- Computer, typing, data entry.
- Excellent telephone and communication skills.
- Strong organizational skills.
Ability to :
- Handle a fast paced, high-volume environment,
- Work in a team environment alongside multiple disciplines.
- Provide guidance and assist in training to peers.
- Have crucial conversations with others / peers.