Patient Access Associate Job Description
Status: Full Time Shift: Working hours vary depending on location and shift. Exempt: No Summary: To provide excellent customer service during the patient access and intake process according to established hospital procedures. The Patient Access Associate executes patient access through the continuum of the revenue cycle that supports patient safety, efficiency, cost reduction, and service improvement.
Responsibilities:
The Patient Access Associate ensures timely and safe access to medical care by completing patient scheduling, insurance verification, and registration processes in an efficient, accurate, and timely manner and according to the department guidelines.
The Patient Access Associate supports the Patient Access Department role in the revenue cycle by scheduling according to patient providers request, reviewing insurance documents, verifying coverage, updating all insurance information in the patients registration, estimating financial responsibility, and collecting payments according to the Patient Access and facility guidelines, policies, and procedures.
The Patient Access Associate is responsible for communicating the purpose of required documents and securing patients signatures as required by department procedures.
The Patient Access Associate contacts patients insurance companies and providers offices by phone or through EMR communication applications using excellent customer service for reasons including but not limited to demographic and insurance information to support timely and accurate billing of all payers.
The Patient Access Associate demonstrates basic knowledge of payer types, including but not limited to Commercial, Medicare, Medicare MCO, Medicaid, Medicaid MCO, Other Governmental, Managed Care, Workers Compensation, and Self Pay, to schedule, verify coverage, secure authorization, provide payer notification, and register patients according to the department procedures and payer requirements.
The Patient Access Associate demonstrates verbal understanding of terminology as it relates to insurance guidelines, including but not limited to Co-payment, Co-Insurance, Deductible, Maximum, Out of Pocket, Allowable, Payable Rates, Payer Notification, Pre-Certification, Prior Authorization, Guarantor, Primary, Secondary, Tertiary, Coverage, Coordination of Benefits, and Explanation of Benefits.
The Patient Access Associate documents in appointment and/or account notes as well as any appropriate comment fields as instructed in relation to scheduling, insurance verification, authorization, or registration of the patient.
The Patient Access Associate interacts with relevant departments, including but not limited to Ancillary Departments, Revenue Integrity, Financial Services, Information Technology, Health Information Management, to solve problems and coordinate any concerns related to patient identification, registration, scheduling, insurance verification, or billing issues.
The Patient Access Associate assists in patient conflict resolution to ensure timely access to care as well as to facilitate a positive patient experience.
The Patient Access Associate is responsible daily for working assigned work queues to resolve account errors and claim edits timely and accurately to support the facilitys financial goals.
Requirements:
Experience: One year of previous experience in the healthcare field or customer service required. A bachelors degree can be substituted for one year of experience.
Specialized or Technical Education: High school diploma or equivalent. Ability to read, understand, and follow oral and written instructions.
Manual or Physical Skill: Requires manual dexterity sufficient to operate a keyboard, telephone, copiers, and other office equipment as is necessary. Vision must be sufficient to read computer screens and printed documents, and hearing must be in the normal range for telephone contact. It is necessary to view and type on computer screens for long periods. Work may also require sitting for long periods of time as well as stooping, bending, and stretching for files, supplies, or other materials. Must be able to occasionally push a patient/visitor in a wheelchair when needed.
Physical Effort: Strength, Light, Push Occasionally, Pull Occasionally, Carry Occasionally, Lift Occasionally, Sit Frequently, Stand Occasionally, Walk Frequently.
Additional Responsibilities:
Maintaining the appearance of the waiting lobby area, calling housekeeping when necessary.
Discussing problems and/or confidential information only in an appropriate setting and only with appropriate personnel.
Responding to inquiries from patients, relatives, physicians, insurance companies, and the public quickly and efficiently by actively listening and taking appropriate action.
Performing appropriately in difficult situations by remaining calm, professional, and notifying appropriate personnel and initiating appropriate action.
Keeping any confidential documents secure and out of public view.
Maintaining a par level of supplies and communicating to the leader/designee when supplies are needed.
Ensuring equipment is functional and ready for service, including paper levels in copiers, printers, and fax machines.
Establishing effective relationships with co-workers in their own department as well as other departments.
Assisting others and showing willingness to work as a team player.
Reviewing, verifying, and updating the patients primary care provider at each visit.
Pulling and preparing patient charts prior to appointment as well as identifying any missing items needed for scanning or updating them in records.
Reconciling all daily encounters, deposit details, and any other necessary paperwork to comply with the facilitys deposit procedures.
Recognizing diagnosis and CPT codes as necessary to complete scheduling, registration, insurance verification, authorization, notification, price estimates, and order transcription as assigned.
Ensuring Emergency Medical Treatment and Labor Act (EMTALA) compliance by registering patients according to department/hospital guidelines.
Removing and labeling broken equipment or furniture from patient and visitor areas and notifying a supervisor.
Calling for all other service repairs as needed.
Assisting patients and visitors in way-finding.
Maintaining the complete and accurate entry of all Patient Information into the EMR, including but not limited to: a. Patient Demographics b. Advanced Directives c. MSPQ Data d. Payment Information e. Deposits f. Deposit Validation g. Preferred Language h. Interpreter Needs i. Release of Information j. Patient Rights and Responsibilities k. Conditions of Treatment l. Financial Disclosure m. Mail/Package Receipt and Delivery n. Coordination of Benefits o. Preference of Communication p. Current Payer information q. Authorization Notification r. Provider Network Status Notification
Communicating regularly with patients in the waiting area and ensuring that the patients are fully informed of delays. Escalating and facilitating resolutions when delays become significant.
Maintaining a professional demeanor and confidentiality with patients, caregivers, visitors, physicians, and co-workers.
Enhancing professional growth by participating in education programs, attending staff meetings, and participating in committees as required.
Assisting with review, monitoring, and working the no-show wait list and cancelation report as assigned and identifying opportunities for continuous quality improvements.