Access Service Representative - Admitting - Chula Vista/Coronado - Evenings and Nights - Per Diem

This position is covered by a Collective Bargaining Agreement (CBA) with SEIU-UHW. As part of the terms of employment, employees in this role are required to join the union within 31 days of hire and remain a member (e.g. dues paying, fee paying, religious exception contributor) for the duration of the collective bargaining agreement. The position was originally posted to ratified SEIU members and is now available to internal candidates not in the ratified Bargaining Unit or external candidates.

Schedule

Variable shift start and end times. 8-hour shifts, 40 hours per week. Weekend requirements: every other weekend. On-call: not required.

Pay

Hourly pay range: $27.830 – $33.390 – $37.400.

Responsibilities

• Coordinates all registration functions to ensure clean claim processing, including obtaining and processing patient demographics, visit, and financial information to facilitate maximum financial reimbursement and promote premier customer service.
• Uses Patient Secure to identify accurate patient medical records while adhering to EMTALA regulations and performs face-to-face interviews with patients or their representatives.
• Ensures accurate identification and delivery of regulatory documents and secures patient financial responsibility.

Collections

• Follows department guidelines for providing patients with estimate letters.
• Requests payment of co-pay, deductible, estimated out-of-pocket costs, or good-faith deposits per department and hospital policies.
• Negotiates partial payments if the patient is unable to pay the requested amount.
• Receives and processes funds, prints and files receipts, and updates Centricity visit comments.
• Secures all funds and receipts according to department standards.

Insurance Verification and Evaluation

• Completes insurance verification and evaluation after medical screening (ER settings).
• Obtains health benefit coverage, including possible accident-related coverage, and inputs information into Centricity Insurance Verification (IF).
• Searches for potential coverage through MCA for SRS/SCMG and MPV (or Portal) for Medicare or Medi-Cal if the patient cannot provide insurance.
• Uses Coordination of Benefits (COB) standards to prioritize the billing order of insurance plans.
• Completes the Medicare Secondary Payer (MSP) questionnaire for Medicare patients.
• Validates insurance eligibility electronically (e.g., MPV, Experian) when applicable.
• Validates health benefit coverage, including accident-related coverage, and identifies the Primary Medical Group for HMO patients.
• Notifies clinical staff, including physicians, about out-of-network patients.
• Estimates patient out-of-pocket costs based on department guidelines and collects financial responsibility.
• Communicates unusually high out-of-pocket costs, limited coverage, or out-of-network (OON) insurance to patients and leadership following facility guidelines.

Unfunded Patients

• Initiates interviews for unfunded or underfunded patients.
• Inputs financial screening results into Pointcare fields and provides potential coverage options.
• Completes the process by recording the outcome through the X8 function.
• Completes the Hospital Presumptive Eligibility (HPE) process when appropriate.
• Documents in Centricity visit comments if the patient declined or completed financial screening.
• Follows the self-pay process (toolkit) to discuss Sharp’s out-of-pocket expectations.

Customer Service

• Uses AIDET, key words at key times, On-Stage Behavior, and supports 5-star patient satisfaction results.
• Communicates effectively both orally and in writing to perform essential job functions.
• Uses tact and empathy when working with customers under stressful situations and frequent interruptions.
• Avoids abbreviations when communicating with patients.
• Adapts and protects patient privacy as needed (e.g., lowering voice, using face sheets vs. verbal interviews).
• Practices good interpersonal and communication skills and contributes to a team environment.
• Maintains a positive and constructive attitude at all times.
• Negotiates with others, handles minor complaints, and settles disputes or conflicts.
• Performs service recovery when The Sharp Experience does not meet standards, following department and Sharp’s Behavior Standard Service Recovery guidelines.
• Identifies solutions to issues not covered by verbal or written instructions.

Initiative and Teamwork

• Prioritizes job responsibilities effectively.
• Keeps management informed of backlogs or slow volume.
• Rounds on patients when volumes are low, as identified by the department.
• Processes patients timely based on department standards such as quality audits, time, and production measurements.
• Offers to assist others and asks for assistance when needed.
• Informs patients/families of admission delays and causes if known or allowed.
• Promotes a team approach in completing department duties.
• Contributes to department production by maintaining expected productivity levels.

Other Duties

• Provides ongoing support for department and hospital needs as directed by leadership.
• Collects and secures patient valuables according to policy, logs them, and drops them into the department safe.
• Follows hospital policy to release valuables.
• Updates Patient Type, Bed Placement, Accommodation Code, and Attending Physician when applicable.
• For ED Unit Clerk (SCO only):
  • Handles outgoing/incoming Emergency Department calls, including consultations and ancillary services, and documents calls in the EMR.
  • Obtains medical records and facilitates transfers from/to outside facilities.
  • Creates patient charts for physicians and organizes charts for the HIM department.
  • Compiles workers' compensation paperwork for the ED physician.
  • Monitors ED café supplies.
  • Handles outgoing calls to other departments for the ED.
  • Inputs discharge disposition information from EHR orders into the patient admission-discharge-transfer (ADT) application.
• For Customer Information Center duties (SCO only):
  • Initiates ED Code calls using the overhead paging system and Code Log Book online.
  • Answers CIC phone lines after business hours and monitors alarm panels for incoming Codes.

Patient Registration

• Patient Safety:
  • Authenticates and/or enrolls patients at workstations with Patient Secure palm scanners, following established guidelines such as scripting and picture identification.
  • In the absence of a Patient Secure workstation, uses at least two patient identifiers to confirm identity.
  • Notifies DUPREG and documents potential duplicate and overlap registrations when identified.
• Demographic Collection:
  • Populates all demographic screens for new and established patients.
  • Follows registration guidelines for Doe and Trauma patients when applicable.
  • Updates regulatory fields in demographic data with patient choices on forms such as Notice of Privacy Practice (NPP), Advanced Directive for Health Care (ADHC), and Health Information Exchange (HIE).
  • Secures patient signature on address attestation.
  • Updates appropriate visit fields for accident-related services.
  • Follows defined documentation processes for homeless patients (e.g., notating "SB1152" in FirstNet and Edit Visit (EV) form comments).

Regulatory Responsibilities

• Observes EMTALA regulations (Emergency Room/ER settings) by avoiding financial discussions (e.g., eligibility, copays, authorization) until medical screening is completed.
• Avoids discussing financial issues with clinical counterparts, health insurances, or patient family/friends until after medical screening.
• Reviews Conditions of Admission (COA) with patients using scripting. If unable to secure a signature, documents the reason in Centricity visit comments.
• Updates Centricity fields related to ADHC, No Publish, Notice of Privacy Practices, and Patient Rights based on COA review.
• For Tricare or Medicare/Medicare Advantage patients, reviews and delivers appropriate regulatory forms (e.g., Tricare Rights, Tricare Third Party Liability, Important Message from Medicare (IMM)).
• Updates Centricity fields if signatures are secured; otherwise, documents the reason in visit comments.
• Follows guidelines for delivering Medicare Outpatient Observation (MOON) and Outpatient Observation Notice (OON) to patients admitted in Observation status.
• Requests and inputs Primary Care Provider (PCP) information and initiates the Health Information Exchange (HIE) process as appropriate.
• Addresses outstanding alerts in the Centricity Alerts Manager based on department workflow for areas performing post-regulatory review.
• Secures and scans necessary Access Service-related documents to the correct form/identifier.

Requirements

• 2 years of experience in a business service setting.
• Experience communicating effectively both verbally and in writing in a professional manner.

Preferred Qualifications

• High school diploma or equivalent.
• Experience communicating and discussing personal and financial matters with patients or their representatives.
• HFMA certifications preferred.

Skills

• Knowledge of medical terminology.
• Knowledge of insurance, billing, and collections guidelines/criteria.
• Knowledge of local, state, and federal regulations governing registration and billing activities, including Joint Commission, Title XXII, Medicare, and Medi-Cal regulations.
• Knowledge of ICD-10, CPT, and/or RVS coding.
• Knowledge of Medicare Important Message, Medicare Secondary Payer, Tricare Third Party Liability, Auto Accident and Work Comp, and Medicare/Outpatient Observation Notice.