Patient Access Rep

Summary of Essential Functions

• Knowledgeable of the insurance information required to properly process insurance claims and ensure prompt payment.
• Knowledgeable of hospital policies concerning all admissions and registrations.
• Fully versed in all aspects of the admitting office and the emergency room functions and duties.
• Knowledgeable and obtain legal forms mandated by law.

Educational Requirements

• High School Diploma or equivalent.
• Must be able to communicate effectively in English, both verbally and in writing.

Qualifications/Knowledge/Skills/Abilities

• Clerical skills and background is needed to perform the functions of the job.
• Admitting, insurance, collections and medical terminology are helpful.
• Clerical abilities (typing, spelling, and communication).
• Previous admitting/registration experience is helpful and desired.
• Past collection and insurance experience is desired.
• Must type 40 wpm and good clerical, communication, spelling, and public relation skills are required.
• Requires the use of office equipment, such as computer terminals, telephones, copiers, 10 key calculators and other various office equipment.
• Having patience and understanding is a must.
• Flexible hours/scheduled according to needs of the department.
• Ability to work under pressure and stress.

Physical Requirements

• Requires eye-hand coordination and manual dexterity.
• Requires corrected vision and hearing to normal range.
• Must distinguish the difference between numbers and symbols.
• On occasion may require some lifting up to 20 pounds.
• Will be required to assist patients to their rooms, by walking, pushing in a wheelchair or calling nursing to assist.

Duties and Responsibilities

• Ensures that highest possible customer service is delivered to both internal and external customers. Proactively approaches dissatisfied customers and implements customer service recovery measures to satisfy displeased customers.
• Conducts a thorough search of patient name against the Eclipsys Master Patient Index (EMPI) in order to eliminate the risk of duplicating or making errors in selecting the correct patient or establishing a new Medical Record Number (MRN). Follows policy and procedures that govern the naming conventions, search practices and notification of changes to the MPI core data elements. Utilizes all systems available to verify information provided by patients/families. This includes collecting a copy of the patients(s) or guarantor’s drivers’ license(s) and insurance card(s).
• Inputs third party payer information, according to what plan is considered primary payer, secondary payer, etc. Establishes the correct assignment of payer based on COB training materials. The department sets performance targets associated with write offs, denials and rejections. The target must be achieved in order to meet performance expectations.
• To provide the highest possible customer service, patients are preregistered 2 working days to 2 weeks in advance of appointment/admission date daily. Contacts insurance company(ies) and notifies them of the patient’s admission within next business day of admission and/or in accordance with Payer’s contracted guidelines. Works with Utilization Review department and physician’s offices to ensure that clinical requirements are obtained. Enters all benefits and pre-cert information in the account notes as instructed. Provides efficient documentation of time and person whom talked to when obtaining benefits and pre-certification data.
• Based on benefit information obtained from the patient’s insurance company, creates an accurate good faith estimate letter. Utilizes all available resources to obtain CPT & Procedure Codes i.e. CPT/Procedure Code books, websites, Medical Records Coding Help Line ect.
• Provides patient/family with information on advanced directives, patient rights, consent for treatment, and obtains appropriate signatures. Prepares necessary patient packets and completes charts. Scans insurance cards, patient identification cards, and other admitting documents.
• Quotes patient’s co-share responsibility (co-payments, deductibles, & out of pocket amounts) to patient, negotiates payment options that lead towards compliance and minimizes collection expenses. Provides assistance applications to all patients with no or inadequate funding. Documents receipts of funds from patient and gives copy to patient at time of transaction. Files receipt of funds in department files. Reconciles petty cash count and reports overage/shortage to supervisor daily.
• Will follow established procedure to ensure that Medicare Secondary Payer Questionnaire (MSPQ) are collected and accurately entered into the registration system. Will insure that Medicare A and/or Medicare B, along with any other applicable coverage, are shown in the correct position(s) on the Insurance Plan Screen in Eclipsys, and if not, to make the appropriate corrections.
• Completes special assignments completely and in a timely manner, is quick to assist, demonstrates ability to work under deadlines and pressure. Works with Management in a positive manner when reporting trouble accounts.
• Performs all other tasks/responsibilities as necessary.