Patient Access Asso Level I

Job Code: 101 | Non-Exempt

About the role

The Patient Access Associate I will perform duties after an eight-week training program under the supervision of the Patient Access Leadership Team and Revenue Cycle Quality & Assurance Training Team. This position is a customer service champion responsible for delivering great customer service at each entry point throughout the health system. This role supports organizational goals by providing high-level, quality customer service, participating in performance improvement efforts, demonstrating a commitment to teamwork and cooperation while verifying and preparing all patient accounts for inpatient and outpatient billing to maximize payment for Hospital and Clinic services from all sources.

Responsibilities

• Perform patient pre-registration, registration, general admissions, and financial assistance processing.
• Be knowledgeable of state and federal government funding programs such as Medicare, Medicaid, TRICARE/CHAMPUS, Workers' Compensation, No Fault Auto, and commercial insurance payers.
• Understand billing and reimbursement guidelines and methodologies for state, federal, and non-government payers; insurance terminology; basic medical terminology, EMTALA, HIPAA privacy, and compliance practices.
• Ensure all demographic and insurance information is obtained and correct; scan IDs and insurance cards as needed.
• Send queries for insurance eligibility information to validate eligibility and benefit information; accurately document in the registration system.
• Inform patients of insurance in/out of network status; complete the Medicare Secondary Payer Questionnaire for all Medicare-eligible patients.
• Verify insurance information through payor contact via telephone, online resources, or electronic verification system.
• Verify diagnosis codes and complete medical necessity checks for Medicare; have basic knowledge of ICD-10 for accurate diagnosis entry.
• Identify and obtain payor authorizations, pre-certifications, and/or referrals; provide appropriate documentation and follow-up to physician offices, case management, and payors regarding authorization/referral deficiencies.
• Communicate to service line partners when rescheduling is necessary due to lack of authorization and/or limited benefits, as approved by clinical personnel.
• Notify payers of patient admissions to the facility in a timely manner for inpatient accounts.
• Identify all patient financial responsibilities, calculate estimates, collect payments due (including current estimated liabilities, outstanding balances, and self-pay deposits), post payment transactions, and perform daily reconciliation.
• Escalate self-pay and complex liability calculations to Financial Counselors as appropriate; handle all estimates requested for consumer shopper comparison.
• Collect and/or set payment arrangements with patients or their representatives; schedule payments on deposits due, including screening for enrollment in available credit option programs.
• Document all collection attempts using approved verbiage, timely and consistently; proactively seek assistance to improve collections.
• Refer patients with billing questions or concerns to appropriate resources, including initiation of financial counseling when needed.
• Document pertinent activity on the patient account via notes.
• Maintain current and thorough knowledge of online and system tools; work from manual reports during system downtime.
• Communicate and collaborate with Patient Access team members and other ancillary departments as needed.
• Attend all required training and in-services; pass all competency tests associated with the in-services.
• Perform additional duties as assigned within the Patient Access job scope.

Requirements

• High school diploma or equivalent.
• 0-1 year experience in healthcare registration or relevant customer service environment.
• Knowledge of general computer and data entry functions.
• Excellent communication, organizational, and analytical skills.
• Excellent customer service skills with internal and external customers.
• Ability to work in a very fast-paced environment.
• Reliable means of transportation.

Qualifications

• Previous experience in a physician's office or hospital setting is preferred.
• Healthcare Financial Management Association (HFMA) Certified Revenue Cycle Representative (CRCR) certification preferred, not required.
• Bilingual preferred.

Performance Expectations

• Demonstrate competencies as established on the Assessment and Evaluation Tool for this position.
• Pass annual recertification with a score of 95% or better; re-take training and exam until the appropriate grade is achieved.
• Maintain a high accuracy rate of 98% or higher and established productivity rates for Key Performance Indicators (KPI) such as cash collections, wait and turnaround times, pre-registration, and registration productivity.
• Opportunity for advancement to Patient Access Associate II after 15 months if all requirements are satisfied.

Work Environment

• Potential exposure to hazards and risks of the hospital environment, including infectious disease, hazardous substances, and potential injury.
• Requires reaching, stooping, kneeling, and crouching approximately 25% of the workday.
• May require pushing and pulling computers on wheels up to 100% of the day if assigned to the Emergency Department or Labor and Delivery.
• High-volume, fast-paced environment.

Benefits

• Generous Paid Time Off (PTO).
• Medical, prescription drug, dental, and vision insurance.
• Retirement plans with employer contributions.
• Short-term and long-term disability coverage.
• Life and accidental death & dismemberment insurance.
• Tuition reimbursement to support educational goals.
• Flexible Spending Accounts (FSAs) for healthcare and dependent care.
• Wellness programs.
• Voluntary benefits, including pet insurance and more.

Benefits offerings may vary based on position and are subject to eligibility requirements.