ED Patient Access Representative Team Lead

About the role

This position serves as a resource to the ED & Main Admissions Patient Access Supervisors and leadership team, supporting front line Patient Access Representatives in the ED, L&D, and Surgical Day areas. The team lead ensures that all areas are covered as needed, manages patient registration and billing information, and provides support in obtaining and verifying patient insurance information.

Responsibilities

• Delivers outstanding customer service to both internal and external customers.
• Ensures the integrity of the data in the hospital's information system with respect to patient demographic, insurance, and admission information.
• Verifies patient insurance using various methods.
• Applies knowledge of payer requirements and guidelines to ensure effective reimbursement.
• Conducts patient interviews.
• Secures patient valuables.
• Documents accurate information on all patient accounts to ensure an effective workflow throughout the organization.
• Demonstrates ability to handle difficult situations by using effective problem-solving skills.
• Serves as a resource for patients and others with questions regarding registration, insurance eligibility, and patient admission.
• Collects insurance copays from patients.
• Collaborates with others to ensure a positive and effective patient experience.
• Utilizes supervisor or manager to resolve issues/concerns as needed.
• Attends and participates in departmental meetings.
• Communicates effectively with internal and external customers with respect to differences in cultures, values, beliefs, and ages, utilizing interpreters when needed.
• Completes MassHealth’s curriculum for Certified Application Counselor and renews certification annually.
• Utilizes Work Queue to identify patient accounts requiring follow-up assistance to complete pending applications.
• Contacts patients by phone, email, and/or letter through USPS to obtain required verification documents to complete and submit applications for enrollment.
• Tracks status of submitted applications until processed with a final disposition.
• Verifies and updates active insurance on all accounts with covered dates of services, closes financial tracker, and documents final disposition of application in electronic medical record system.
• Secures retroactive coverage from MassHealth for non-covered dates of service in accordance with regulations.
• Contacts MassHealth and other out-of-state Medicaid providers to review pending cases or request expedited applications.
• As needed, assists patients in appealing denied applications.
• For patients determined ineligible for public entitlement programs or QHPs, screens for eligibility through BMC’s Charity Care Program (CCP).
• Affords assistance in applying for BMC Charity Care Program.
• Obtains signed applications and required verification documents to process and determine patients' eligibility for free or reduced care.
• Updates patient accounts with billing indicator, CCP Pending, to temporarily disable applicable accounts from further billing action, pending a final determination of eligibility.
• Processes CCP applications and issues written notifications regarding patient's application status (i.e., Approved or Denied).
• If "Approved," removes pending billing indicator, updates accounts with CCP coverage, and adjusts balances according to patients' determined eligibility status.
• If "Denied," removes CCP Pending billing indicator, updates accounts to Self-Pay to ensure that Self-Pay discount is applied.
• Contacts patients, in writing and by phone, to discuss payment options and assist in establishing payment plans.
• Collects and posts payments on patient accounts with outstanding balances.
• Utilizes protected software programs to track pending applications and verify approvals for MassHealth, Health Safety Net, and ConnectorCare.
• Responds to billing questions and advises patients on options available to resolve account balances (i.e., payment plans, self-pay discount, and BMC Charity Care Program).
• Submits written reports of work activity as requested and in a timely manner; completes daily, weekly, and/or monthly statistics to document the volume of patients encountered, and number of successful enrollments or denied applications.
• Demonstrates superior customer service standards.
• Participates in regular staff meetings and scheduled trainings as required to meet or exceed established, qualitative goals for productivity and core competencies.
• Provides pricing estimates for elective services, as requested, if patient is uninsured or if services are uncovered by payer.
• Under the direction of a Manager, assists with orientation and training of new staff as assigned.
• Understands and adheres to rules established by the BMC Credit and Collection Policy.
• Protects patient and family confidentiality.
• Reviews all identified quality assurance errors and remedy within 48 hours of notification.

Qualifications

• High School Diploma/GED Certificates.
• MassHealth’s Certified Application Counselor and maintains certification renewal annually.
• 3+ years of hospital registration or financial assistance related experience or 5 years customer service experience.
• Bilingual persons and persons with hospital and/or healthcare experience strongly preferred.