Patient Access Representative

Key Responsibilities

• Always follow AIDET (Acknowledge, Introduce, Duration, Explanation, Thank You) guidelines in all interactions with the patient.
• Maintain professional image and demonstrate excellent customer service.
• Maintain accurate patient identification using two patient identifiers (full name and date of birth).
• Perform pre-registration and insurance verification within 3-5 days prior to date of service for both inpatient and outpatient services.
• For notification received with less than 3 days’ advanced notice, perform within 24 hours of notification.
• Meet/exceed performance expectations; completes work within the required time frame (10 registrations per hour).
• Follow scripted benefits verification and pre-certification format in Health Information System (i.e. Meditech) custom benefits screen and record benefits and pre-certification information in the approved standard format.
• Assign Insurance Plans (IPlan’s) accurately.
• Perform electronic insurance eligibility confirmation and document results.
• Complete Medicare Secondary Payor Questionnaire as applicable for retention in imaging system.
• Calculate patient cost share and be prepared to collect via phone or make payment arrangement and document account with collection efforts accordingly.
• Contact patient via phone (with as much advance notice as possible, preferably 72 hours prior to date of service) to confirm or obtain missing demographic information, quote/collect patient cost share, and instruct patient on where to present at time of appointment.
• Receive and record payments from patient for services scheduled.
• Utilize appropriate communication system to facilitate communication with Patient Access team and other hospital departments as necessary.
• Ensure appropriate documentation is entered in standard format on the patient record.
• Contact physician to resolve issues regarding prior authorization or referrals.
• Research Patient Visit History to ensure compliance with payor specific payment window rules.
• Perform insurance verification and pre-certification follow up for prior day’s walk-in admissions/registrations and account status changes by assigned facility as per guidelines.
• Communicate with hospital-based Case Manager as necessary to ensure prompt resolution of pre-existing, non-covered, and re-certification issues.
• Complete ABN’s (Advanced Beneficiary Notice) on all Medicare patients.

Qualifications

• Demonstrate knowledge and understanding of organizational policies, procedures and systems.
• Participate in process improvement initiatives.