Patient Access Representative 1 - ED Night

About the role

The Patient Access Representative I in the emergency room serves as the first point of contact for patients and visitors, ensuring smooth registration and intake processes. This role involves gathering accurate patient information, verifying insurance details, and facilitating timely communication between patients, medical staff, and other departments. Strong customer service skills and the ability to work efficiently in a fast-paced environment are essential.

Responsibilities

• Effectively meet customer needs, build productive customer relationships, and take responsibility for customer satisfaction and loyalty.
• Represent the Patient Access department in a professional, courteous manner at all times.
• Ask patients if they may have special needs; greet patients by name in a courteous and professional manner.
• Prioritize and complete registration in a consistent, courteous, professional, accurate, and timely manner.
• Accurately identify patients that present to the ER without proof of legal identification (e.g., ID card, driver’s license, passport) due to EMTALA regulations.
• Obtain necessary information from patients, including demographic and insurance details, and correctly input it into registration software.
• If the patient is already in the system, find the correct patient record and verify the information.
• Use critical thinking skills to evaluate each registration situation and customize the experience based on individual patient circumstances.
• Apply knowledge of federal and state laws (EMTALA, HIPAA, Balanced Billing Act, Participating Provider statute, HITECH law, workers' compensation regulations, victims of sexually oriented criminal offenses regulation, 2-midnight rules, ABNs, patient status requirements, MSPs, and state regulations on notification of out-of-network status) to ensure compliant registration.
• Manage the special needs of patients, family members, and visitors during active traumatic situations and disaster events.
• Coordinate registration intake of trauma, stroke, and heart alerts to ensure timely triage.
• Ensure each patient is assigned only one medical record number.
• Communicate the purpose of and obtain patient/legal guardian signatures on all necessary hospital documents (e.g., hospital consent forms, assignment of benefits, patient rights).
• Extensively document each encounter in account notes to ensure successful cross-function communication.
• Ensure orders are received and are consistent with tests/procedures.
• Monitor the waiting room, facilitate patient flow, and resolve issues regarding orders or missing/conflicting information to ensure timely and accurate patient registration.
• Effectively communicate with patients, family, visitors, EMS, RNs, and providers simultaneously.
• Demonstrate knowledge of insurance plans, including understanding of varying payer rules and requirements related to insurance coverage.
• Verify eligibility (utilizing online eligibility software tools whenever possible) and obtain necessary authorizations for services rendered.
• Select correct insurance plans in the registration software, in the correct order (primary versus secondary).
• Understand required forms (including Medicare Secondary Payer Questionnaire) and explain them to the patient.
• Utilize payment estimator software to calculate patient financial responsibility, using critical thinking skills to verify accuracy.
• Determine when patients may be eligible for financial assistance and direct them to appropriate resources.
• Use proven customer service techniques and scripting to collect the patient financial obligation at or before the time of service.
• Negotiate with patients to ensure a deposit is collected in accordance with corporate policy and procedure.
• Understand and explain the details of the out-of-pocket calculation.
• Collect out-of-pocket responsibility at the patient bedside without prior benefit information while navigating around the patient care team.
• Analyze documentation/notes on current and previous accounts to explain balances to the patient.
• Demonstrate knowledge and ability to complete account acknowledgement forms when appropriate.
• Collect cash, print receipts, and balance cash drawers.
• Perform all other duties as assigned.

Qualifications

• Experience: 1 year of customer service experience or related certification (e.g., Certified Coder, Certified Medical Assistant).
• Education: High School diploma or equivalent.
• Special Skills: Advanced clerical and computer skills, critical thinking skills, ability to work in high-stress situations, professional appearance and behavior, good communication skills, dependability, flexibility, teamwork.