Patient Access Coordinator Lead-AOC's FT 8:30-5:00

Responsibilities

• Provides education and training/mentoring for other staff members.
• Conducts and attends department meetings and reviews procedural & process changes per facility specific guidelines.
• Aids and clears accounts for billing from WQ’s established.
• Ensures new associate orientation is completed.
• Must present a positive role model.
• Facilitates Performance Improvement processes.
• Responsible for staffing issues during on-call coverage.
• Interviews patients and obtains and verifies appropriate personal demographic and financial information for the purposes of ensuring: (1) quality patient care through proper patient identification and (2) maximal reimbursement for all billable clinical services rendered.
• Assesses and updates information as it relates to each encounter.
• Determines financial plan and coverage priority.
• Analyzes patient accounts; evaluates financial data for Establishment of current accounts and documents comments to reflect actions taken regarding accounts to maximize reimbursement.
• Prioritize organizations participation in insurance contracts.
• Maintain knowledge of current HMO/PPO/Medicaid/Medicare/commercial insurance regulations and requirements.
• Requires working knowledge of Insurance Plans the Christ Hospital participates in.
• Determines all insurance coverage’s as primary, secondary, tertiary, etc.
• Completes required MSPQ questionnaires for all appropriate patients.
• Obtains and documents clinical referrals from other providers.
• Coordinates Patients in need of financial assistance to pay for present and/or future services to appropriate Financial Counselor.
• Collections and deposits according to specified protocols, all required and mandatory insurance co-payments.
• Initiates on-line verification of third party Insurance Carriers and Plan Administrators to verify patient benefits.
• Evaluates and prepares chart documentation to establish that Medical Necessity guidelines have been met.
• Prepares and completes documentation that establishes Medicare Compliance such as Medicare Secondary Payor Questionnaire and Advance Beneficiary Notice.
• Documents appropriate data in Account Doc and guarantor notes.
• Prepares daily census statistics, reconciles patient days and patient type changes.
• Effectively facilitates room assignment for patients admitted for an inpatient, observation, or ambulatory stay who require recovery time utilizing established medical criteria for patient placement.
• Coordinates all internal and external transfers.
• Processes Emergency, Obstetrics, newborns and elective admissions as needed.
• Answers and directs incoming calls, schedules from physicians, Physician’s office staff, ancillary departments and other facilities.
• Answers inquiries concerning hospital policies, processes orders for patients placed in bed.
• Determines organizations participation in insurance contracts.
• Knowledge of current HMO/PPO/Medicaid/Medicare/Commercial Insurance regulations and requirements.
• Screens and completes all required documentation and prioritizes all insurance coverage’s as primary, secondary, tertiary.
• Completes required MSPQ questionnaires for all appropriate patients.
• Obtains and Documents clinical referrals from other providers.
• Coordinates Patients in need of financial assistance to pay for present and/or future services to appropriate financial counselor.
• Collections and deposits according to specified protocols, all required and mandatory insurance co-payments.
• Documents appropriate data in Account Doc and guarantor notes.
• Audits work completed by registration to ensure compliance with Medicare and all third party payor guidelines, inclusive of JCAHO standards.
• Obtains signatures for the visit including consent to receive all treatments, medications, test, transfusions, therapy and other procedures.
• Charts procedures in the respective patient medical record, all collected forms and photocopies (insurance cards) documentation.
• Distributes, witnesses by signature and collects patient advanced directive forms/information; referring patients to appropriate personnel to address specific questions as indicated.
• Provides patients with information about their rights and responsibilities and all other duties as assigned.
• Maintains facility established productivity and quantity standards per Department Quality Guidelines (i.e. 100% accuracy of 95% of all registrations).

Qualifications

• High School Diploma, Associates Degree preferred or equivalent combination education and experience.
• One to three years experience in Registration, Billing, Customer Service, or Managed Care Organization work environment.
• Must have/gain knowledge of the Hospital Medical Staff rules and infection control policies to be effective in this position.
• Analytical skills required to make decisions based on the facility and clinical situation at hand.
• Computer Literacy – use of multiple systems Epic, Passport, OnBase, Cisco, Microsoft Office products.
• Ability to use Internet Access and utilize third party payor systems for eligibility and verification.
• Knowledge of health insurance coverage, requirements.
• Excellent communication, problem solving skills, and ability to deal with customers who are often adversarial.
• Ability to be flexible, organized and function well in stressful situations.
• Ability to interact Independently to resolve Customer Service issues.
• Typing (minimum of 35 words per minute or equivalent key strokes).
• Must understand medical terminology and be able to determine bed placement based on condition and the contra indication of roommates/isolation needs.
• Coordinates placements of patients with RN Supervisor based on medical condition.