Patient Access Specialist

DEPARTMENT: PATIENT ACCESS

F ACILITY: Tift Regional Medical Center

WORK TYPE: PRN

S HIFT: Varied

SUMMARY

The Patient Access Specialist is generally the first point of contact for patients entering the facility or scheduling appointments. The Patient Access Specialists role includes scheduling physician ordered exams, obtaining pre-certification/prior-authorization (as required), collecting patient responsibilities, and registering patients system-wide.

RESPONSIBILITIES

• Obtain and verify patient demographics, guarantor and insurance information for new or established patients either by telephone or face to face for inpatient and outpatient population system-wide in accordance with departmental policy.
• Create a patient/case record in the ADT registration system in accordance with established policy and procedures for inpatient, ambulatory surgery, non-patient laboratory, radiology and/or other diagnostic ancillary tests/services.
• Answer telephones and transfer calls to appropriate personnel and departments.
• Schedule outpatient hospital exams system-wide as ordered by physicians in an accurate and timely manner, in accordance with department standards and protocols.
• Analyze insurance information/reason for admission or encounter to determine pre-certification and/or pre-authorization requirements.
• Contact insurance carriers to obtain pre-certification and pre-authorization numbers. Contact patients/providers offices as needed to verify/obtain data.
• Ensure the patient record is updated with accurate information and the insurance record reflects all appropriate insurance, appropriately prioritized. (coordination of benefits)
• Ensure all registrations are completed prior to discharge.
• Ensure all deductibles and co-payments are collected in accordance with insurance benefits and departmental policy for inpatient and outpatient population
• Ensure patients are apprised of advanced beneficiary notice, as appropriate and in accordance with Medicare Medical Review Policies.
• Provide cross coverage to other Patient Access locations as needed.
• Assist in other projects as needed and as assigned by department leadership.
• Promote excellent customer service to internal and external customers.
• Providing cost estimates for all required patients system-wide to ensure compiance with the Good Faith Estimate Act.
• Maintaining productivity standards as outlined by leadership.
• Adhering to Point of Service (POS) collections standards as outlined by leadership.
• Verifies that the minimum data set for all orders is obtained prior to scheduling/registration
• Scanning in of valid forms of ID, Insurance card, and Physician Order
• Informs patient of Consent for Treatment, Patient Bill of Rights, Joint Privacy Practice, and other required admission forms at the point of service.
• Keeps abreast of pertinent federal, and state regulations and laws and Tift Regional Health System, Inc. (“TRHS”) policies as they presently exist and as they change or are modified.
• Understands and adheres to: TRHS’ compliance standards as they appear in TRHS’s Corporate Compliance Policy, Code of Conduct and Conflict of Interest Policy; and HIPAA and TRHS policies regarding privacy and security of protected health information.
• Demonstrates the ability to perform tasks that meet the age-specific requirements of the persons, patients, vendors, and staff that the employee is charged to interact with as required by the position.
• Offers suggestions on ways to improve operations of department and reduce costs.
• Attends all mandatory education programs.
• Improves self-knowledge through voluntarily attending continuing education/certification classes.
• Maintains required competency levels as identified in written exams, skills checklists, skills labs, annual safety and health requirements as well as service excellence education hours requirements.
• Cross-trains in order to better assist co-workers and to provide maximum efficiency in the department.
• Volunteers/participates on hospital committees, functions, and department projects.
• Manages resources effectively.
• Reports equipment in need of repair in order to extend life of equipment and removes malfunctioning equipment out of service with timely reporting to the appropriate personnel.
• Makes good use of time so as to not create needless overtime.

EDUCATION

• High School Diploma or Equivalent

OTHER INFORMATION:

One (1) year of applicable medical office/hospital based customer service experience preferred.

CHAA certification preferred.

Southwell/Tift Regional Health System, Inc. is an Equal Opportunity Employer.