PATIENT ACCESS REPRESENTATIVE I-3

Primary Duties and Responsibilities

OBTAINS/CONFIRMS AND ENTERS/UPDATES DEMOGRAPHIC AND INSURANCE INFORMATION FOR ALL PATIENTS

• Consistently confirms, enters, and/or updates all required demographic data on patient and guarantor in registration system(s) on a daily basis to achieve maximum payment.
• Secures and/or explains copies of insurance card(s), forms of ID, and signature(s) on all required forms and scans them into the appropriate imaging documentation system.
• Consistently completes the Medicare Secondary Payer (MSP) questionnaire, if applicable.
• Discusses Advanced Directives with patients and obtains a copy for the patient's record, if available.
• Reviews all other regulatory forms and information with the patient, such as Notice of Privacy Practice and Billing information.
• Verifies insurance using Real Time Eligibility, Payer Website, or phone number to determine coordination of benefits and obtains authorization and/or referrals as required.
• Follows procedures to accurately identify a patient and apply the patient identification bracelet, if applicable.
• Registers patients during downtime following downtime procedures and enters data into registration system immediately upon system availability.
• Performs Service Recovery as needed at the point of service with patients and visitors.

VERIFIES INSURANCE COVERAGE, SCREENS PATIENT FOR POTENTIAL FUNDING SOURCES, AND SETS EXPECTATIONS FOR REIMBURSEMENT OF SERVICES.

• Verifies financial information to determine insurance coordination of benefits, pre-certification/prior-authorization requirements by contacting the insurance company or through other verifying technology.
• Informs self-pay patients of prepayment requirements or screens for funding sources.
• Prepares estimate of procedures, calculates advance payment requirements, informs patient of acceptable payment arrangements on previous and current balances.
• Refers potentially eligible patients to contract eligibility vendor(s) to pursue funding reimbursement.
• Coordinates with clinical areas to establish patient financial expectations and assist in the resolution of revenue cycle issues.
• Maintains up to date knowledge, requirements, and skills to perform daily duties and meet key performance metrics for the facility, unit, and payers.

COLLECTS, POSTS, AND RECONCILES ALL PAYMENTS FROM PATIENTS

• Consistently collects patient payments and provides receipt accurately completing all required fields.
• Calls patient prior to date of service to inform them of their expected financial liability. Will educate patient on their respective benefits and accept payment over the phone is patient agrees.
• Coordinates with appropriate providers when payment is unable to be collected from the patient. If necessary, secure a waiver for services.
• Accurately posts all payments on system.
• Accurately reconciles receipts with cash collected and completes required balancing forms at the end of their shift.

Knowledge, Skills, and Abilities

• Excellent customer service skills are required.
• Ability to receive and express detailed information through oral and written communications.
• Uses proper negotiation techniques to professionally collect money owed by our Patients/Guarantors.
• Knowledge of insurance plans and benefits.
• Computer literate and able to operate in multiple applications such as Microsoft Office.
• Minimum typing skills of 35-40 wpm (certified typing test results required).
• Requires eye-hand coordination and manual dexterity.
• Requires the use of office equipment, such as computer terminals, telephone, and copiers.
• Knowledge of medical terminology.
• Able to handle multiple tasks simultaneously.
• Ability to work weekends, Friday, Saturday, and Sunday. Must be flexible and able to work flex and staggered shifts.
• Requires substantial amount of walking.

Education Requirements (Essential Requirements)

• Associate Degree or High School Diploma with 2 years of customer service experience.
• Patient Access Certification (preferred).
• One (1) year relevant experience in a medical office or hospital preferred.

High school diploma or equivalent (GED), with 1 year of customer service experience. Ability to interpret and apply financial procedures and regulations preferred. Previous experience with hospital information systems or word processing preferred.