Patient Access Representative

Position Purpose This position is responsible to perform all registration, scheduling, order entry, and reception functions and may float to various admitting sites within the health system. This position expedites and provides healthcare access through the accurate gathering of demographic, sponsorship, or guardian data, insurance, clinical, financial, and statistical information from a variety of sources, i.e., patients, patients families, physicians, physician office staff, county and/or governmental agencies, CMS, FMS, etc. This position ensures reimbursement for services rendered through verification of insurance eligibility/benefits, obtaining insurance authorization within the required time frame, identification and collection of patient financial obligation, and accurate charge order entry. Serves the patient and family in such a manner as to make the admission process as comfortable and pleasant as possible.

Nature and Scope The incumbent uses professionalism and diplomacy when interacting with patients of all ages, their families, physicians, physician office staff, and other health care providers in the accurate collecting of demographic, clinical, and financial information in person or via telephone interviews. Takes an active role in decreasing accounts receivables by following established guidelines, regulations, policies, and procedures during the registration process in accurately obtaining and accurately entering demographic, clinical, and financial information into the computer system.

• Explaining and obtaining signatures on admission, clinical, and financial forms.
• Collecting accident information.
• Identifying all insurance payer sources.
• Identifying payer order sequence.
• Verifying insurance eligibility.
• Obtaining insurance notification.
• Charge order entry processing.
• Determining estimated cost for services being rendered.
• Identifying and collecting patient financial obligation amounts, i.e., co-payments, co-insurance, deductibles, etc.
• Documenting all information collected timely and in accordance with department requirements.
• Explores the financial need of the patient and, when appropriate, refers the customer to the appropriate federal, state, or county assistance agencies.

The incumbent is responsible for scheduling, order entry, and reception functions and assists in completion of departmental tasks. This position has the authority to solve problems following established company guidelines. Decisions that must be referred to a supervisor are matters that involve problems which can develop negatively towards the company, time off requests, sick time, work schedules, interoffice problems, etc.

1. Adopts a philosophy consistent with the Renown Health Values and models them.
2. Ability to be diplomatic and effectively communicate during stressful situations.
3. Skills to anticipate customer needs, deal with the unexpected, establish priorities, investigate, and adjust performance style when necessary. This includes the ability to deal with the sight of various injuries, procedures, and the stress associated with such an environment.
4. Working knowledge of health care insurance. The ability to accurately document subscriber information, determine payer order sequence, and obtain notification as required by payer for services being rendered.
5. Must be able to ensure all matters related to patient information are kept secured, meeting confidentiality compliance standards set by The Joint Commission and HIPAA.
6. Knowledge of governmental programs billing requirements.
7. Ability to identify the patients financial obligation, i.e., deductible, co-payment, co-insurance, etc., and follow standard operating procedures regarding point of service collections.
8. Skills to perform order entry.
9. Above average computer application skills.
10. Ability to follow verbal and written instructions.
11. Scheduling skills adaptable to a fast-paced environment with heavy physician/physician office staff interaction.
12. Ability to be flexible and adapt to different Admitting department locations. This includes the ability to prioritize/multitask in a fast-paced environment.

This position does not provide patient care.

Disclaimer The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Minimum Qualifications Requirements - Required and/or Preferred

NameDescription

Education Must have working-level knowledge of the English language including reading, writing, and speaking English. High School Diploma or GED preferred.

Experience Requires six months of admitting, medical claims processing, professional office experience, and/or customer service experience with financial interaction. One year preferred. Experience with Windows Operating systems, SMS, InVision, Internet, and SMS IMS Document Imaging is also preferred.

Licenses

Certifications

Computer Typing: Must possess or be able to obtain within 90 days the computer skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.