Patient Access Representative

About the role

Under the general supervision of the Supervisor, and according to established policies and procedures, you will interview and register all patients (Inpatient and Observation, Emergency, and Outpatients) to obtain demographic, third-party insurance, and related financial information, and enter it into the online computer system. You will initiate, review, and follow up on patient accounts to ensure proper data collection for billing, verify all demographic and insurance information, and obtain referrals as required.

Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence. Additionally, all employees are expected to demonstrate core Success Factors: Instill Trust and Value Differences, Patient and Community Focus, and Collaborate.

Responsibilities

• Greet and direct all patients, families, and visitors in a prompt and courteous manner.
• Interview patients or their representatives to obtain complete and accurate third-party health insurance and related personal/financial information.
• Follow up on missing data by interviewing patients, families, or calling employers, nursing homes, and other facilities.
• Complete registration and enter all data obtained into the hospital computer system.
• Ensure patient is properly identified in the system per department policy.
• Verify demographic and insurance information by asking open-ended questions.
• Register all patients (Outpatient, ED, Inpatient, and Observation) by entering and/or verifying demographic and insurance information into the hospital information system.
• Upgrade account to an active account status and complete documentation required on financial clearance reports.
• Utilize online tools and/or telephone to verify coverage, determine level of benefits, and confirm that the primary care physician (PCP) matches the PCP recorded in the hospital system.
• Contact insurance carriers or companies for missing information when necessary.
• Notify the Pre-Registration Office if coverage changes from pre-admit/pre-registration information.
• Identify primary and secondary insurers and properly record insurance information in the system.
• Complete lien forms upon determination that a liability exists and enter financial notes into the system.
• Gather paper referrals from patients when required by the payer and update the system with appropriate documentation.
• Contact Financial Counselor/Pre-Registration Office if insurance does not verify or if the patient does not have a referral when required by the payer.
• Determine self-pay balances for all patients using the system.
• Use reference tools to determine the expected payment due at the time of service.
• Contact Patient Financial Advocate to estimate expected payment on complex cases.
• Refer patients to Patient Financial Advocates if they cannot meet the expected payment according to defined criteria.
• Collect co-payments as required per financial clearance or third-party payor/department policy, including cash, check, and credit card payments.
• Document collections in the system, log payments, and provide receipts per department policy.
• Complete financial clearance screens in the system.
• Explain consent, financial, and insurance forms to patients or their designees and provide general hospital information regarding policy and procedure.
• Obtain patient signatures on all required forms (e.g., Privacy notice, Ethics brochures, Patient Rights, Hospital Directory).
• Generate patient registration records, plates, and distribute appropriate copies.
• Verify and update all information, make required plates, bracelets, and face sheets, and place bracelets on patients per department policies.
• Utilize hospital department scheduling and workflow reports to complete daily work.
• Communicate with service departments to obtain order information as required.
• Communicate with Financial Counselor/Pre-Registration Office to obtain authorizations not obtained at or prior to the time of service.
• Ask patients for Advance Directives and include them with admission paperwork; provide information on Advance Directives if one is not prepared.
• Explain and have patients sign Advance Beneficiary Notice (ABN) as required.
• Complete medical necessity checks utilizing the order entry system per hospital policy if not done during pre-registration.
• Distribute Payment Policy brochures when patients lack evidence of adequate health insurance coverage.
• Refer patients to Patient Financial Advocate to assist with applications for medical coverage (Medicaid, RIte Care, etc.) or Community Free Service, and to establish payment plans.
• Notify physicians' offices by phone or fax of patient arrival to the Emergency Department and/or admission to the hospital per department policy (ER patients only).
• Upgrade Observation to Inpatient accounts per department/hospital policy when appropriate.
• Pre-admit/pre-register scheduled outpatients and inpatients in the hospital system.
• Contact insured patients to verify demographics obtained at the time of scheduling to complete any missing information.
• Verify patient insurance coverage(s), both primary and secondary, online or by telephone.
• Obtain and verify all other information required to secure payment through sources such as Worker’s Compensation, MSP, Medicare liability, liens, etc.
• Ensure referrals are obtained and confirm the accuracy of the PCP.
• Establish the level of insurance benefits and expected payment for selected services.
• Determine the patient’s portion of payment, when applicable, and arrange for payment prior to the provision of services.
• Check outstanding balances incurred for previous services prior to contacting the patient and follow collection policy concerning prepayment prior to additional services.
• Collect prepayments by phone or mail if there is enough time before admission or outpatient services; otherwise, instruct the patient to bring payment at the time of arrival.
• Refer insured patients who cannot meet their financial obligations to Patient Financial Advocates (in accordance with department policy).
• Update the status of financial clearance activities in the system.
• Prepare all necessary paperwork prior to the patient’s arrival.
• Review/correct third-party payer eligibility reports and complete real-time status transfers.
• Authorize occupancy and collect payment for Private Room differentials.
• Review the bed transfer list daily to ensure the authorization and collection of all appropriate private room transfers.
• Monitor in-house accounts for open patient balances resulting from co-payments and deductibles.
• Track Medicare days and Lifetime Reserve Days, when applicable.
• Negotiate payment of balances before discharge and/or visit patient rooms to do so when required.
• Review all accounts prior to discharge to clear patients financially and/or direct them to the Patient Advocate as required by department policy.
• Complete any missing documentation and paperwork required from patients and/or family members at arrival, admission, or in the patient’s room.
• Provide bed control by assigning patients to appropriate rooms whenever possible and notify nursing units.
• Coordinate with the Nursing Department to assign patient beds in accordance with case management guidelines.
• Explain the policy for private room requests and collect deposits when applicable.
• Monitor the bed tracking system for bed availability and bed status.
• Coordinate bed cleaning with the ESD department whenever necessary.
• Review newly assigned medical record numbers for duplication and report all duplicates on the appropriate form.
• Attend and participate in staff meetings.
• Provide coverage to numerous locations (hospital-based Admitting, ED, and Outpatient areas as well as off-site registration areas) as needed to meet patient/customer needs.
• Protect and preserve patients' right to privacy and confidentiality.
• Utilize department equipment (e.g., fax machine, phone, Visa machine, laptop PC, and other technology as developed).
• Perform other related duties as required to support the operations of the Department.

Requirements

• High school diploma or equivalent.
• Knowledge of medical terminology, third-party insurance information, and standard office computer applications.
• Knowledge of third-party payer verification and authorization process preferred.
• Typing and data entry skills required.
• Six to twelve months of previous third-party billing or hospital registration experience.
• Third-party billing knowledge, data entry skills, and PC experience required.

Work Environment and Physical Requirements

• Sitting for long periods at a workstation requiring continuous use of a computer and telephone.
• Moderate to excessive walking, depending on the location of the assignment.
• Ability to lift up to 10 pounds.

Pay

Pay Range: $18.13 - $29.90 per hour

Schedule

• Every other weekend: 5:00 PM - 11:30 PM
• Daily hours: 8 hours
• Shift: Evening