Patient Access Representative

About the role

We are searching for a Patient Access Representative to join our team. The ideal candidate will generate clean bills for primary, secondary, and tertiary payers, maximize upfront collections, minimize exposure of accounts at risk, and ensure clean account receivable balances.

Responsibilities

• Interviews patients and relatives to obtain necessary personal and financial information for admission/registration.
• Verifies insurance benefits and documents the verification process in the system.
• Enters all admitting/registration activities into the system in a timely manner.
• Implements policies and procedures for admission/registration of all patients.
• Re-verifies eligibility when applicable, such as for Medicare and Medi-Cal patients.
• Accurately maintains daily census in both paper and system formats.
• Completes required forms for admission/registration and provides patients/families with all necessary documentation.
• Documents all admitting/registration activities and ensures accurate estimated financial responsibilities are communicated to patients.
• Documents all collection efforts and reviews the out-of-pocket yield report daily.
• Ensures patients are provided with information about payment options and financial assistance processes, and finalizes these arrangements before discharge.
• Maintains communication with clinical staff, MDs, other Revenue Cycle departments, and Administration regarding eligible days/visits and "At-Risk" notifications.
• Maintains accuracy of information related to actual denial activity and disseminates relevant information to relevant parties.
• Prepares and submits requests for adjustments, refunds, and transfers as needed to accurately reflect appropriate AR balances.
• Monitors self-pay accounts to ensure applicable self-pay rates are applied and accounts are appropriately contractualized.
• Maintains compliance with State and Federal collection laws and demonstrates understanding of various "Self Pay" account classifications and their applicable patient statement processes.
• Reviews self-pay balances with credit balances and processes refunds (both by check and credit card) for approval.
• Collaborates with Assessment & Referral and Case Management staff to optimize pre-admission activities and minimize clinical denials.
• Works with the Centralized Business Office to enhance overall collection efforts.

Requirements

• High School degree or equivalent required. Bachelor's degree preferred.
• No licenses required.
• Three to five years of admitting and/or financial counseling experience preferred.
• Basic PC skills including Windows Operating System, Microsoft Outlook, Word, and Excel.
• Knowledge of governmental and managed care payer requirements.
• Understanding of the data elements required to generate a clean bill.
• Confidentiality under HIPAA standards.
• Diplomacy, excellent customer service, and interpersonal communication skills.
• Strong verbal and written communication skills in English. Additional language abilities desirable.
• Basic math and modern office procedures knowledge.
• Ability to work well under pressure, sit for extended periods, and perform repetitive motions.