Patient Access Representative 1 - ED (North BR)

Responsibilities

• Effectively meets customer needs, builds productive customer relationships, and takes responsibility for customer satisfaction and loyalty.
• Represents the Patient Access department in a professional, courteous manner at ALL times.
• Asks patients if they may have special needs.
• Calls patients by name, Greets patients in a courteous and professional manner.
• Prioritizes and completes registration in a consistent, courteous, professional, accurate and timely manner.
• Accurately identify patients that present to the ER without proof of legal identification (Identification card, Driver’s license, Passport, etc.) due to EMTALA regulations
• Obtains necessary information from patient, including demographic information, insurance, guarantor, and correctly inputs it into registration software.
• If patient is already in the system, finds correct patient record and verifies information in the system.
• Uses critical thinking skills to evaluate each registration situation to ensure customized registration experience based on individual patient circumstances.
• Uses knowledge of federal and state laws (EMTALA, HIPAA, Balanced Billing Act, Participating Provider statute, HITECH law, worker's compensation regulations, victims of sexually oriented criminal offenses regulation, 2 midnight rules, ABN's, Patient status requirements, MSPs, and state regulations on notification of out-of-network status) to ensure compliant registration
• Coordinates registration intake of trauma, stroke and heart alerts to ensure timely triage
• Sets up and maintains patient records
• Ensures each patient is assigned only one medical record number.
• Communicates the purpose of and obtains patient/legal guardian signatures on all necessary hospital documents such as Hospital consent forms, assignment of benefits, patient rights, etc.
• Extensively documents each encounter in account notes to ensure successful cross-function communication.
• Maintains patient flow by monitoring the waiting room, facilitating patient flow, and resolving issues regarding orders or missing/conflicting information, to ensure timely and accurate patient registration.
• Effectively communicate with patient, family, visitors, EMS, RNs and providers simultaneously

Insurance and Benefits Knowledge

• Demonstrates knowledge of insurance plans, including understanding of varying payer rules and requirements related to insurance coverage
• Verifies eligibility (utilizing online eligibility software tools whenever possible)
• Obtains necessary authorizations for services rendered.
• Selects correct insurance plans in the registration software, in the correct order (primary versus secondary).
• Has understanding of required forms (including Medicare Secondary Payer Questionnaire) and has ability to explain them to the patient.
• Utilizes payment estimator software to calculate patient financial responsibility.
• Uses critical thinking skills to determine correct data input during the estimate process and to verify accuracy of output.
• Determines when patients may be eligible for financial assistance and directs patients to appropriate resources.

Financial Collections

• Uses proven customer service techniques and scripting to collect the patient financial obligation, at or before the time of service.
• Understands and explains the details of the out-of-pocket calculation.
• Expectation to collect out-of-pocket responsibility at patient bedside without prior benefit information prior to service while navigating around patient care team
• Analyzes documentation/notes on current and previous accounts in order to explain balances to the patient.
• Demonstrates knowledge and ability to complete account acknowledgement forms when appropriate.
• Collections cash, prints receipts, and balances cash drawers.

Qualifications

• 1 year customer service experience or related certification (e.g. Certified Coder, Certified Medical Assistant)
• High School diploma or equivalent
• 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.