Patient Access Representative 1 (On-Site) Full Time - Bascom Palmer - Miami, FL

Full-time, on-site position at the University of Miami, Bascom Palmer Eye Institute in Miami, Florida.

About the role

The Patient Access Representative 1 registers patients for clinical services by obtaining pertinent information, verifying insurance benefits, and collecting payments.

Responsibilities

• Performs full registration and ensures insurance is verified and all patients’ information is correct.
• Obtains copies of insurance cards, driver’s license, and any applicable referrals.
• Explains Consent for Treatment, Financial Liability, and HIPAA to patients and obtains signed forms.
• Instructs patients to complete any questionnaires required by the physician.
• Schedules follow-up, cancels, and edits appointments, and records no-show patients accurately.
• Reconciles all vouchers and delivers them to the designated area.
• Answers telephone calls and responds to questions and inquiries or transfers when appropriate.
• Adheres to University and unit-level policies and procedures and safeguards University assets.

Scheduling

• Coordinates scheduling of all walk-in, add-on, and follow-up appointments in accordance with established guidelines and in multiple systems (e.g., UChart Cadence/Prelude/Enterprise Billing, UMCare, RIS/PAC).
• Enters and/or updates all pertinent data including demographics, financial, and referring physician information.
• Interacts with patients and collaborates with providers and clinicians to appropriately schedule appointments, considering scheduling guidelines per division/specialty/provider, resource availability, special needs, timeframes, medical necessity, and payer and contractual guidelines.
• Determines appointment type and utilizes analytical skills to determine appropriate slot utilization and instances when overbooking is appropriate.
• Obtains and documents pertinent insurance verification information (e.g., CPT codes, service description, reason for visit) needed to obtain authorization/pre-certification to avoid denials and ensure financial reimbursement.
• Coordinates multiple appointments with appropriate sequence and proper time allotted between appointments.
• Communicates to the patient the place of service where each appointment will take place (e.g., POS 11 vs. 22) and how it may impact their financial responsibility.

Ancillary/Clinic Support Services

• Performs ancillary/clinic support duties which vary by hospital departments and specialties (e.g., ER, Admitting, CTU, Imaging, Bariatrics, Dermatology, Infertility, Mental Health, OB GYN, Oral Surgery, Pediatrics, Plastic Surgery) including but not limited to:
  • UChart Office Assistant functions and monitoring of Provider’s In Basket Messaging
  • Processing of Back to Work or School Requests and Immunization Records
  • Scanning Imaging Results
  • Preparing Charts/Medical Records
  • Processing of Medical Record Release of Information
  • Prescription Refill Requests
  • Test Results Requests
  • Treatment Plans
  • Appointment Reminder Calls
  • Bump Lists
  • Surgery Scheduling
  • Coordination of External Referrals
  • Promotion and Sales of Over-the-Counter Products
  • Inventory and Ordering of Supplies
  • Ordering of DME products
  • Bed Assignments
  • Pre-certifications

On-site Registration (Check-in/Admission)

• Performs all on-site patient access registration-related functions promptly without compromising patient safety, quality, service levels, and reimbursement.
• Obtains legal photo identification and (if applicable) insurance card(s), and validates patient identity and coverage prior to services being rendered.
• Scans ID, insurance card(s), advance directives, share of cost letters, and any other pertinent documents.
• Obtains and/or verifies that all demographic, financial, and insurance coverage information is accurate, up-to-date, and complete, ensuring financial clearance has been obtained inclusive of all required referrals/authorizations.
• Explains all applicable forms (e.g., Consent for Medical Treatment, Acknowledgement of Receipt of Privacy Practices, Questionnaires, Important Message from Medicare, Advance Directives Checklist) and answers any questions patients may have.
• Obtains and witnesses all patient/guarantor signatures on all applicable consents and forms, ensuring all required areas are completed, dated, timed, and labeled.
• Prints out labels and/or any forms required by the treatment area.
• Completes check-in and registration process as rapidly as possible to minimize patient wait time.

Insurance Verification/Financial Clearance

• Verifies insurance eligibility, obtains all applicable referrals/authorizations/pre-certifications, and confirms that non-emergent visits have been financially cleared prior to services being rendered.
• Verifies insurance eligibility and authorization requirements for walk-ins and add-ons utilizing multiple automated online resources or telephone.
• Identifies point of service (POS) 11 versus 22 and obtains verification and referral/authorization accordingly.
• Provides patient/guarantor with detailed benefit and authorization requirements and co-pay, deductible, and co-insurance self-pay responsibility for POS 11 and 22.
• Ensures the appropriate payer has been selected (e.g., Indemnity, HMO, PPO, POS, Auto, W/C) and that all required data elements, referrals, and authorizations based on CPT, ICD-9, and services being rendered have been obtained and accurately entered into the system.
• Refers non-contracted payers for single case negotiation.
• Determines appropriate filing order if the patient is covered by more than one payer.
• Financially clears visits once insurance has been verified and referrals/authorizations obtained.
• Generates HAR (Hospital Account Record) for all services rendered at POS 22 and assigns HARs to appointments accordingly.

Compliance

• Complies with all established UHealth policies and procedures related to Patient Access and State/Federal regulations.
• Completes the Medicare Secondary Payer Questionnaire (MSPQ) at the time of scheduling prior to services being rendered in accordance with CMS Federal regulations.
• Utilizes medical necessity software to determine if an Advance Beneficiary Notice (ABN) is applicable, produces and provides all Medicare patients with an ABN in accordance with CMS Federal regulations, explains the ABN in detail, and documents in the system.
• Identifies patients enrolled in a Study/Transplant program and validates that the account reflects the appropriate coverage(s) as it relates to the Study/Transplant program to ensure accurate billing.

Collections

• Identifies and collects patient’s self-pay responsibility including co-pays, deductibles, co-insurances, self-pay discount rates, global packages, and previous outstanding balances for both technical and professional components in POS 11 and 22 clinics.
• Exercises sound judgment so as not to delay treatment for emergency medical conditions due to patient’s financial responsibility and collection efforts.
• Determines and collects patient’s estimated financial responsibility for both POS 22 and POS 11 (e.g., deductible, co-payment, co-insurance, prompt payment discounts, or global fee based on CPT/ICD-9 codes).
• Explains charges, fees, and previous balances for both technical and professional components.
• Offers forms of payment including cash, checks, and credit cards.
• Checks for counterfeit bills when collecting cash and obtains authorization for all credit card transactions.
• Posts payment(s) as applicable for both POS 11 and 22 and issues system-generated receipt(s).
• Reconciles all collections and transactions at the end of the shift including initial cash bag funds.
• Prepares daily deposit(s) for Med Finance, Main Cashier, or contracted armored pick-up service.
• Documents any and all collection details including discounts, global fees, and partial payments in the system and selects applicable billing indicators and FYI Global/Discount flags.

Financial Counseling

• Provides upfront financial counseling services at the time of check-in, including identifying alternate funding resources and establishing payment plans.
• Advises patients of financial obligations and collects according to established guidelines and financial policies.
• Identifies alternate funding sources and offers global or discount.
• Identifies patients deemed eligible for charity care or financial hardship and determines if services being rendered are encompassed in charity approval.
• Assists patients in establishing payment plans.

Discharge/Departure

• Coordinates discharge process including identification and collection of additional self-pay charges, prompt scheduling of all follow-up appointments, procedures, diagnostic testing, appointment status update, voucher/facility fee reconciliation, and After Visit Summary (AVS).
• Determines upon checkout/discharge any pending financial responsibility and collects and posts payment(s) accordingly.
• Systematically reflects the checkout/discharge status by updating the appointment status to complete.
• Checks discharge orders and coordinates the prompt scheduling of any follow-up appointment(s)/procedure(s), diagnostic, or ancillary services ordered.
• Prints and provides the patient with an After Visit Summary (AVS).
• Obtains applicable vouchers, facility fee, and/or secondary forms and screens for accuracy.

Front End Revenue Cycle Quality Control

• Complies with all standard operating procedures established to support key metrics and quality assurance initiatives that contribute toward prompt billing and increased cash flow.
• Identifies systematic warning flags/messages and populates required data elements to eliminate bypassed warnings/errors and avoid a negative impact on downstream revenue cycle processes.
• Monitors and clears patient work queues on a daily basis to ensure data integrity, prompt billing, and minimal AR days.
• Populates all required data to ensure the checklist at the end of the arrival process reflects as complete for each category.

Charge Entry

• Accounts for and enters accurate charges within the established time frame.
• Enters charge codes and amount of units accurately and within one business day of services being rendered.
• Performs daily reconciliation to identify missing charges and follows up with clinical areas as needed.

Requirements