Patient Access Lead

About the role

The Patient Access Lead functions as an integral member of the team and is the first point of contact for all people inquiring about the provider's practice. The primary role is to organize the practice's daily activities and paperwork.

Responsibilities

• Maintains up-to-date knowledge of specific registration requirements for all areas, including but not limited to: Main Admitting, OP Registration, ED Registration, Maternity and Rehabilitation units
• Ensures complete, accurate and timely entry of demographic information into the ADT system at the time of registration
• Properly identifies the patient to ensure medical record numbers are not duplicated
• Responsible for reviewing assigned accounts to ensure accuracy and required documentation is obtained and complete
• Meet CMS billing requirements for the completion of the MSP, issuance of the Important Message from Medicare, issuance of the Observation Notice, and other requirements, as applicable and documenting completion within the hospital's information system for regulatory compliance and audit purposes
• Collections and enters required data into the ADT system with emphasis on accuracy of demographic and financial information to ensure appropriate reimbursement
• Carefully reviews all information entered in ADT on pre-registered accounts. Verifies all information with patient at time of registration; corrects any errors identified
• Identifies all forms requiring patient/guarantor signature and obtains signatures
• Ensures all required documents are scanned into the appropriate system(s)
• Identifies all appropriate printed material hand-outs for the patient and provides them to the patient/guarantor (Patient Rights and Responsibilities, HIPAA Privacy Act notification, Advance Directive, etc.)
• Follows "downtime" procedures by manually entering patient information; identifying patient's MRN in the MPI database, assigning a financial number; and, accurately entering all information when the ADT system is live
• Follows EMTALA-compliant registration steps for both Emergency Department and Labor and Delivery areas
• Assesses self-pay patients for presumptive eligibility and when appropriate, initiates the process
• In the Emergency Department follows protocol for special cases, including but not limited to 5150, Sexual Assault Response Team (SART), Domestic Violence patients, Child Protective Services, incarcerated patients, Worker Compensation patients, auto accidents, animal bite reporting, etc. as required
• Makes sure to monitor and address tasks associated with the Mede/Analytics PAI tool
• Follows approved scripting, verify insurance benefits on all patients registered daily by using electronic verification systems or by contacting payers directly to determine the level of insurance coverage
• Thoroughly and accurately documents verification information in the ADT system, identifying deductibles, copayments, coinsurance and policy limitations
• Obtains referral, authorization and pre-certification information; documents this information in the ADT system and submits notices of admission when necessary
• Verifies medical necessity checks have been completed for outpatient services. If not completed and only when appropriate, uses technology tool to complete medical necessity check and/or notifies patient that an ABN will need to be signed. Identifies payer requirements for medical necessity
• Verifies patient liabilities with payers, calculates patient's payment and requests payment at the time of registration
• Identifies any outstanding balance due to previous visits, notifies patient and requests patient payment
• Sets up payment plans for patients who cannot pay their entire current copayment and/or past balance in one payment
• Thoroughly and accurately documents the conversation with the patient regarding financial liabilities and agreement to pay
• When collecting patient payments, the department policy and procedure follows regarding applying payment to the patient's account and providing a receipt for payment
• Clarifies division of financial responsibility if payment for services is split between a medical group and an insurance company. Ensure this information is clearly documented in the ADT system
• When necessary, escalates accounts to appropriate Patient Registration leadership staff, based on outcomes of the verification process and patient's ability to pay clinic(s)

Qualifications

• High School Diploma/GED (or higher)
• 2+ years of experience in analyzing and solving complex customer problems
• 1+ years of Patient Access and/or Patient Registration experience
• Ability to work 100% onsite at 350 W. Thomas Road in Phoenix, AZ
• Must be 18 years of age or older

Preferred Qualifications

• 1+ years of experience with prior authorizations
• 1+ years of team lead experience in patient access
• Experience with Microsoft Office products
• Experience in requesting and processing financial payments
• Experience in insurance reimbursement and financial verification
• Working knowledge of medical terminology
• Understanding of insurance policies and procedures
• Able to perform basic mathematics for payment calculation

Soft Skills

• Strong interpersonal, communication and customer service skills

Physical and Work Environment

• Standing for long periods of time (10 to 12 hours) while using a workstation on wheels and phone/headset

Benefits

Our mission of helping people live healthier lives extends to our team members. Learn more about our range of benefits designed to help you live well.

Life

• Resources and support to focus on what matters most to you, in every facet of your life.

Emotional

• Education, tools and resources to help you reduce and manage stress, build resilience and more.

Physical

• Health plans and other coverage to support wellness for you and your loved ones.

Financial

• Benefits for today and to help you plan for the future, including your retirement.

Connect with us

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.