Patient Access Services Representative - TMCOne Pulmonology

Essential Functions

• Exhibits excellence in customer service through appropriate attitude and interaction with all patients, visitors and staff ; adheres to and supports team members in exhibiting TMCH values of integrity, community, compassion, and dedication.
• Collects deposits or deductibles and advises patient or guarantor of insurance benefits and anticipated cost estimates; ensures that cash handling follows corporate policies.
• Ensures completion of financial documentation in accordance with TMCH’s credit and collection policies.
• Explains all necessary compliance forms and obtains patient signature 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.
• Uses medical terminology and scheduling knowledge to select correct procedure 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.
• Performs 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, insurance 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 caller for correct procedure in appropriate service area; 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 notification, authorization 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.
• May serve as a Medical Assistant when holds a Medical Assistant Certification.
• 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.

Additional Responsibilities

• Ensures provider’s calendars meet productivity and clinic equipment functions properly.
• Schedules surgeries and obtains any necessary consents.
• Maintains supply stock inventory for exam rooms and overall clinic needs.

Minimum Qualifications

• EDUCATION: High School diploma or General Education Degree (GED), completion of vocational medical office training desired, or an equivalent combination of relevant education and experience.
• EXPERIENCE : Preferred 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.
• LICENSURE OR CERTIFICATION : Some positions may require certification as a Medical Assistant (CMA).