Patient Access Representative

SUMMARY

Brown University Health employees are expected to successfully role model the organization’s values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.

In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include:

• Instill Trust and Value Differences
• Patient and Community Focus and Collaborate

RESPONSIBILITIES

Greets and directs all patients, families and visitors in a prompt and courteous manner.

Interviews patient or patient’s representative in order to obtain complete and accurate third party health insurance and related personal/financial information.

Follows-up on missing data by interviewing patients, families or calling employers, nursing homes and other facilities.

Completes registration and enters all data obtained into hospital computer system. Prepares or completes manual records as follows:

• Ensures patient is properly identified in system per department policy.
• Verifies demographic and insurance information by asking open-ended questions.
• Registers all patients (Outpatient, ED, Inpatient and Observation) by entering and/or verifying demographic insurance information into hospital information system.
• Upgrades account to an active account status.
• Completes documentation required on financial clearance reports as indicated by Patient Advocate or Pre-Registration Office.
• Utilizes online tools and/or telephone to verify coverage, determine level of benefits, and confirm that the primary care physician (PCP) matches the PCP that is recorded in hospital system.
• Contacts insurance carrier or company for missing information when necessary.
• Notifies Pre-Registration Office if coverage changes from pre-admit/pre-registration information.
• Identifies primary and secondary insurer. Properly records insurance information in system.
• Completes lien forms upon determination that a liability exists.
• Enter financial notes into system.
• Gathers paper referrals from patients, when required by the payer. Updates SMS with the appropriate documentation.
• Contact Financial Counselor/Pre-Registration Office if the insurance does not verify or if the patient does not have a referral when required by the payer.
• Utilizes system to determine self-pay balances for all patients.
• Uses reference tools to determine the expected payment due at time of service.
• Contact Patient Financial Advocate to estimate expected payment on complex cases.
• Refers patients to Patient Financial Advocates if patients cannot meet the expected payment according to defined criteria.
• Collections as required per financial clearance or as required by third party payor or department policy.
• Documents collections in system, logs payments, provides receipts per department policy.
• Completes financial clearance screens in system.
• Explains consent, financial and insurance forms to patients or designee and provides general hospital information regarding policy and procedure.
• Obtains patient signatures on all required forms to meet established hospital requirements. i.e. Privacy notice, Ethics brochures, Patient Rights, Hospital Directory, The Miriam Hospital Welcome Brochures.
• Generates patient registration record and plate and distributes appropriate copies.
• Verifies and updates all information. Makes required plates, bracelets, and face sheets. Places bracelet on patients per department policies in accordance with patient identification policy.
• Utilizes hospital department scheduling and workflow reports to complete daily work. Communicates with service departments to obtain order information as required.
• Communicates with Financial Counselor/Pre-Registration Office to obtain authorizations not obtained at, or prior to, time of service. Asks patient for Advance Directive and includes with admission paperwork to go to nursing unit, provides patients with information on Advance Directives if one is not prepared.
• Explains and has patient sign Advance Beneficiary Notice (ABN) as required. Completes medical necessity checks utilizing order entry system per hospital policy if not done during pre-registration process.
• Distributes Payment Policy brochures when patient lacks evidence of adequate health insurance coverage, according to established criteria.
• Refers insured patients who cannot meet their financial obligations including previously incurred hospital balances, current admission/outpatient expected non-covered charges and ABN’s to Patient Financial Advocates (in accordance with department policy).
• Updates status of financial clearance activities in system.
• Prepares all necessary paperwork preparatory to the patient’s arrival.
• Reviews/corrects third party payer eligibility reports.
• Completes real time status transfers.
• Authorizes occupancy and collects payment for Private Room differentials.
• Also, reviews bed transfer list daily to ensure the authorization and collection of all appropriate private room transfers.
• Collection of private room differentials may require visits to patient rooms.
• Marks in-house accounts for open patient balances resulting from co-payments and deductibles.
• Tracks Medicare days and Lifetime Reserve Days, when applicable.
• Negotiates payment of same, before discharge and/or visits patient rooms to do so when required.
• Reviews all accounts prior to discharge to clear patient financially and/or directs patients to the Patient Advocate as required by department policy, if they are not cleared financially at the time of discharge.
• At arrival, at admission or in the patient’s room, may complete any missing documentation and paperwork required from patients and/or family members.
• May provide bed control by assigning patient to appropriate room whenever possible and notify nursing units.
• Coordinates with Nursing Department to assign patient beds in accordance with case management guidelines.
• Explains policy for private room requests and collects deposits when applicable.
• Makes sure bed tracking system for bed availability and bed status is monitored.
• Coordinates bed cleaning with the ESD department whenever necessary.
• Reviews newly assigned medical record numbers for duplication, reporting all duplicates on appropriate form.
• Attends and participates in staff meetings.
• May be required as needed to provide coverage to numerous locations (hospital-based Admitting, ED and Outpatient areas as well as off-site registration areas) to meet patient/customer needs.
• Protects and preserves patients' right to privacy and confidentiality.
• Utilizes department equipment: i.e. fax machine, phone, visa machine, laptop PC and other technology as developed.
• Performs other related duties as required to support the operations of the Department.

MINIMUM QUALIFICATIONS

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