Patient Access Services Representative TMCOne

Summary

Aids medical caregivers with patient management, tracking, and monitoring requirements. Answers phones, screens calls, schedules appointments, handles insurance, and processes payments.

Essential Functions

• Exhibits excellent customer service through appropriate attitude and interactions with all patients, visitors, and staff; adheres to and supports TMCH values of integrity, community, compassion, and dedication.
• Collects deposits or deductibles and advises patients or guarantors on insurance benefits and estimated costs; ensures cash handling follows corporate policies.
• Ensures completion of financial documentation in accordance with TMCH's credit and collection policies. Explains necessary compliance forms and obtains patient signatures as required for regulatory agencies.
• Performs medical necessity screening and ensures compliance with system requirements. Interacts with physicians and/or physicians' office staff to secure diagnosis, procedure details, or authorizations and information for denials as needed.
• Selects correct procedures when scheduling and coordinates information with other departments as needed. Demonstrates knowledge of resources, staffing, instrumentation, and equipment specific to procedures to avoid scheduling conflicts.
• Completes patient registration activities to ensure accurate financial and biographical data and documentation have been obtained and properly entered into hospital records. Completes insurance processing, including account creation, verification, notification, and authorization functions, follow-ups on denials and no response claims.
• Communicates with departments/physicians for special requests, emergent cases, overbooking, and add-ons; informs management about issues/problems with tools/times. Handles incoming telephone calls and exercises judgment in scheduling callers for correct procedures in appropriate service areas; receives telephone requests to schedule from patients, physicians, physician office staff, employers, and hospital personnel, if applicable.
• Explains procedure preparations to patients so they are properly prepared before arriving at the hospital or clinics as needed. Documents all notifications, authorizations, and eligibility information in the registration systems, uses electronic verification tools and web-based resources.
• Analyzes patient accounts, determines non-collectable accounts, and recommends bad debt or charity write-offs when applicable; analyzes and processes contractual write-offs.
• Arranges payment methods or extensions of credit with patients or representatives; evaluates accounts and determines payment dates based on patient’s ability to pay and hospital policies; explains charges, services, and hospital policy regarding payment of bills. Arranges account collections and contacts carriers to follow-up on balances due.
• Maintains current working knowledge of payer regulations, contractual agreements, computer updates, and new collection tools including understanding of the Fair Debt Collection Practice Act. Provides information about external financial assistance, including recommending third parties.
• Processes Accounts Payable transactions such as: checks and posts payments to accounts receivable and verifies account balances; prepares, reconciles, balances, and batches daily deposits and prepares receipts for deposits; verifies totals on reports and forms as required.
• Reviews accounts with unusual balances after posting payments and adjustments. Researches and transfers monies between logs, as needed.
• Adheres to TMCH organizational and department-specific safety, confidentiality, values policies and standards. Performs related duties as assigned.

Minimum Qualifications

• High School diploma or General Education Degree (GED), completion of vocational medical office training desired, or an equivalent combination of relevant education and experience.
• One (1) year of medical office and/or hospital experience to include healthcare eligibility and benefit analysis or scheduling experience for diagnostic testing and/or surgery.
• Some positions may require certification as a Medical Assistant (CMA).