Access Service Representative-pt Focus-sgh

3 weeks ago

La Mesa, United States Sharp Healthcare Full time

[H.S. Diploma or Equivalent
**Hours**:
**Shift Start Time**:
11 PM
**Shift End Time**:
7:30 AM

**AWS Hours Requirement**:
8/40 - 8 Hour Shift

**Additional Shift Information**:
**Weekend Requirements**:
As Needed

**On-Call Required**:
No

**Hourly Pay Range (Minimum - Midpoint - Maximum)**:
$21.000 - $25.922 - $31.106

**What You Will Do**
Coordinates all registration functions necessary to ensure the processing of a clean claim including but not limited to obtaining and processing patient demographics, visit and financial information in a manner that facilitate maximum financial reimbursement and promotes premier customer service. This role utilizes Patient Secure to identify the accurate patient medical record while adhering to EMTALA regulations and performs face-to-face interviews directly with patients and/or their designated representatives. Accurate identification and delivery of regulatory documents and securing patient financial responsibility is a key responsibility.

**Required Qualifications**
- 2 Years experience in a business service setting.
- Must have experience communicating effectively both verbally and in writing professionally.

**Preferred Qualifications**
- H.S. Diploma or Equivalent
- Experience communicating and discussing personal and financial matters with patients and/or their representatives is preferred.

**Other Qualification Requirements**
- HFMA certifications preferred.

**Essential Functions**
- Collections
Follow department guidelines for providing patient with estimate letter.
Request payment of co-pay, deductible, estimated out of pocket or good-faith deposit in a manner specified in department and hospital policies. If patient unable to pay requested amount, negotiate some portion.
Receive and process funds, print and file receipt, and update Centricity visit comments. Secure all funds and receipts in accordance with department standard.
- Completes insurance verification and evaluation
Insurance/Plan Selection:
After medical screening (ER settings), obtain health benefit coverage including possible accident related coverage. Input all insurance coverage information into Centricity Insurance Verification (IF). If patient unable to provide insurance, search for potential coverage through MCA for SRS/SCMG and MPV (or Portal) for potential Medicare or Medi-Cal.
Use Coordination of Benefits (COB) standards to prioritize billing order of insurance plans.
Medicare patients - Medicare Secondary Payer (MSP) questionnaire is completed.
Validate insurance eligibility electronically (e.g. MPV, Experian) when applicable. Validate health benefit coverage including possible accident related coverage.
Validate and identify the Primary Medical Group on Health Maintenance Organizations (HMO) patients. Notify the clinical staff, including physician, on patients that are out-of-network.
Follow process to estimate patient out of pocket based upon department guidelines and collect patient financial responsibility.
Communicate to patient and leadership when unusually high out of pocket, unusually limited coverage, and/or if insurance is out of network (OON) following the guidelines established for the facility.
Unfunded:
Initiate interview on unfunded/underfunded patients. Input financial screening results into Pointcare fields as appropriate and provide patient with potential coverage options. Complete the process by recording the outcome through X8 function.
Complete HPE (Hospital Presumptive Eligibility) process when appropriate.
Document in Centricity visit comments if patient declined or completed financial screening.
Follow self-pay process (aka toolkit) to discuss the Sharp out of pocket expectation.
- Customer service
Use AIDET, key words at key times, On-Stage Behavior and support 5-star results on patient satisfaction.
Communicates effectively both orally and in writing sufficient to perform the essential job functions. Use tact and empathy in working with customers under stressful situations and with frequent interruptions.
Avoid abbreviations when communicating to patient.
Adapt and protect patient privacy as needed (i.e. lowering voice, using face sheets vs. verbal interviews).
Practice good interpersonal and communication skills and ability to work well with others contributing to a team environment.
Practice a positive and constructive attitude at all times.
Negotiates with others, handles minor complaints by settling disputes, grievances, and conflicts.
Perform service recovery when The Sharp Experience does not go right in accordance to the department standards and Sharp's Behavior Standard Service Recovery.
Identify solutions to issues not covered by verbal or written instructions.
- Demonstrates initiative and teamwork
Prioritize job responsibilities effectively. Keep management informed of backlogs or slow volume. Round on patients when volumes are low as identified by your department.
Patients are processed timely based upon depart standards such as quality audits, ti

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