Patient Access Representative PRN

About the role

Texas Children’s is searching for a Patient Access Rep to serve as the liaison between patients/families, payers, Healthcare Information Management (Medical Records), Patient Financial Services (PFS or Business Services) and other healthcare team members.

Responsibilities

• Obtains, verifies, and enters complete and accurate demographic information on all accounts to facilitate smooth processing through the revenue cycle.
• Thoroughly searches the patient accounting system for an existing medical record on each visit.
• Uses appropriate search techniques to ensure that no duplicate medical records are created in the master patient index.
• Accurately enters complete demographic information into the system. Verified information should include correct spelling of patient name, date of birth, gender, address, phone number, guarantor data, etc. Patient names should follow hospital protocol regarding middle names, suffixes, etc.
• Maintains assigned DARs and/or work queues, ensuring all elements of the accounts are secured for billing.
• Financially secures all patient accounts to maximize hospital reimbursement in a customer service oriented fashion.
• Verifies insurance benefits for all plans associated with patient, confirming the correct payor and plan is entered into EPIC.
• Enters patient estimates in estimating software if required.
• Obtains insurance referrals, as required by individual insurance plans, documenting referral numbers in the appropriate fields for accurate billing.
• Documents whether authorization is required and involves Authorization Specialist when needed for clinical authorizations.
• Provides estimates of patient liability to patient/guarantor prior to visit as part of financially securing the account.
• Involves financial counseling department for self-pay accounts requiring assistance with funding.
• To provide the highest possible customer service, patients are pre-registered 2-10 working days in advance of appointment/admission.
• Registers unscheduled patients as soon as notified, obtaining insurance benefits and referrals/authorizations prior to providing services or prior to discharge.
• Verifies inpatient benefits, notifies bed control, and begins the pre-certification process.

Qualifications

• H.S. Diploma required
• 6 months experience as an admissions representative/counselor performing all aspects of the registration process preferred
• Associate or bachelor’s degree may be substituted for the experience