Patient Access Rep (TRH)

About the role

Reports to the Department's Designee. Follows established policies and procedures to admit and register patients for services in a professional and courteous manner. Is responsible for accurate and complete registration of all patients.

Responsibilities

• Collects applicable co-payments and deductibles and completes insurance verification and must be able to accurately decipher eligibility responses and relay that information back to the patient.
• Obtains all required signatures on paperwork and performs clerical duties as necessary.
• Maintains regulatory and functional knowledge of all information required which ensures timely and accurate reporting/billing.
• Registers Patients (in Order To Obtain Demographic, Physician And Insurance Information In Accordance With Established Departmental Policies And Procedures) And Collects Applicable Co-payments And Deductibles By Interviewing patients for pre-admission or upon presentation for admission in the registration or designated area.
• Promptly works alerts through the Teletracking system by creating an account for all direct admits, transfers, and add-on procedures.
• Audits each account for demographic errors by using Financial Clearance Workstation (FCW).
• Updates the system after validation of the new patient's financial information.
• Uses the Pathways Healthcare Scheduling (PHS) or Cerner databases to locate/retrieve scheduled patients for admission/registration input into STAR.
• Generates PHS and SurgiNet reports to facilitate pre-registration.
• Explaining about the possible need to pre-certify with the patient's insurance carrier in order to ensure maximum coverage to the limits of the insured's insurance policy.
• Verifying and documenting insurance coverage via online eligibility systems, internet resources or via telephone.
• Requesting copies of the insurance card(s) and driver's license or other government picture ID to confirm insurance benefits and identification.
• Providing the Medicare letter for Medicare patients; also completing the Medicare Secondary Payor Questionnaire (MSP) and Advance Beneficiary Notice (ABN).
• Validating medical necessity via the MCA Compliance Checker where applicable.
• Completing the MSP (Medicare Secondary Payor) questionnaire by asking the patient the questions based on patient availability.
• Requesting payment either during the pre-registration process or when the patient presents for service in accordance with policies and procedures.
• Posting patient payments (including cash, checks and credit cards) on the patient's account and generating a system receipt to give to the patient.
• Maintaining a cash drawer in order to make the appropriate change for patients making payment at the time of service; also responsible for balancing and reconciling the cash drawer at the end of the shift.
• Referring the patient to the Financial Counselors or Eligibility Specialists if they are unable to secure satisfactory payment arrangements and have a self-pay balance of $500 or more. Also assisting in obtaining additional patient information, copies of insurance card(s) and church information.
• Obtaining all required signatures for the "consent to treat" and assignment of insurance benefits forms.
• Coordinates the insurance eligibility and pre-certification/documentation (PA) processes for patients by:
  • Verifying insurance coverage and network status by using online eligibility systems and websites to determine the patient's benefits under the insurance plan.
  • Audit insurance eligibility by using the Relay Connect dashboard to verify insurance is eligible and correct.
  • Obtaining VOB information from the insurance company, such as: co-payment, co-insurance, deductible, the amount of the deductible that has been met year-to-date, family deductible, maximum out-of-pocket limit and rehabilitation benefits.
  • Obtaining pre-certification information from the insurance company's pre-certification unit (i.e., whether pre-certification is required, if the ordering physician has completed it, etc.).
  • When the ordering physician has not completed the pre-certification, calling the physician's office to initiate the pre-certification process and following up until it has been completed.
  • When the ordering physician has completed the pre-certification, documenting the authorization and releasing the account.
  • Covers other patient services and performs clerical duties by preparing patient statistics (i.e., percentages) regarding completed demographic information as requested by the Department Designee.
  • Processes utilization review emails and physician orders to complete change patient types in Star.
  • Works mismatch report to ensure that all patient types match the level of care order.
  • Printing itemized bills for the patient upon receipt of co-payments or coinsurance (if requested).
  • Entering authorization number in the appropriate field for proper and timely claims filing.
  • Calculating co-payments and coinsurance for services rendered per the insurance companies request.
  • Processing and filing reservations, pre-testing forms and testing results in an efficient manner.
  • Answering the telephone and communicating information in an appropriate manner according to approved MHSB standards and departmental policies and procedures.
  • Notifies the appropriate area of the patient's arrival and ensures that the patient is escorted to the appropriate location by:
    • Notifying the assigned Unit of the patient's arrival.
    • Preparing the patient's chart, ID band and labels for the medical record.
    • Ranging for an escort to assist the patient to the assigned outpatient area or to the patient's room (by wheelchair or by walking with the patient).
    • Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by:
      • Providing world class service at all times.
      • Assisting the department to meet or exceed its quality assurance goals.
      • Greeting and providing information to patients and their families in a professional and friendly manner.
      • Acting as a representative of Beacon Health System and striving to make a good first impression.
      • Striving to accurately process an optimal number of registrations (or pre-registrations) during one's shift.
      • Communicating with the Department Designee regarding any concerns or problems.
      • Maintaining records, reports and files as required by departmental policies and procedures.
      • Performing time of service collections effectively by achieving assigned collections goals and maintaining strong patient relations.
      • Completing other job-related duties as assigned.

Qualifications

The knowledge, skills and abilities as indicated below are acquired through the successful completion of a high school diploma or equivalent is preferred. Must be a minimum of 17 years of age. A minimum of one year of previous hospital or medical office experience is preferred. A medical terminology course must be successfully completed during the first year of employment. Additional college-level courses in the medical practices area are desired. Associate degree preferred. CHAA certification is highly preferred.

Skills

• Basic office and keyboarding skills (with the ability to type a minimum of 40 wpm)
• Effective telephone skills (for example, to accurately take and relay information about patients, physician orders and referrals)
• Proficient computer skills (i.e., data entry, word processing and spreadsheets)
• The ability to use multiple databases (such as Pathways Healthcare Scheduling, RelayHealth, Cerner and MCA Compliance Checker)
• A complete understanding of time-of-service collections
• Basic knowledge of medical terminology, private insurance coverage (and managed care)
• The interpersonal skills necessary to interact effectively with patients from various backgrounds in a professional, enthusiastic, courteous, friendly, caring and sincere manner
• The ability to strictly follow Beacon's policy on confidentiality
• The ability to utilize good judgment and maintain one's composure in stressful situations
• The basic math skills needed to successfully balance a cash drawer

Physical Demands

Requires the physical ability and stamina (i.e., to walk moderate distances, climb stairs, lift up to 15 pounds, reach, bend, stoop, twist, etc.) to perform the essential functions of the position.