Access Management Representative

2 weeks ago

Oceanside, United States Tri City Healthcare District Full time

Job Locations: US-CA-Oceanside Overview:
Tri-City Medical Center has served San Diego County’s coastal communities of Carlsbad, Oceanside and Vista, as well as the surrounding region for more than 60 years and is one of the largest employers in North San Diego County. Tri-City is administered by the Tri-City Healthcare District, a California Hospital District. As a full-service acute care public hospital with over 500 physicians practicing in over 60 specialties, Tri-City is vital to the well-being of our community and serves as a healthcare safety net for many of our citizens. The hospital has received a Gold Seal of Approval® from the Joint Commission showcasing a commitment to safe and effective patient care for the residents of the community.

Tri-City Medical Center prides itself on being the home to leading orthopedic, spine and cardiovascular health services while also specializing in world-class robotic surgery, cancer and emergency care. Tri-City’s Emergency Department is there for your loved ones in their time of need and is highly regarded for our heart attack and stroke treatment programs. When minutes matter Tri-City is your source for quality compassionate care close to home. Tri-City partners with over 90 local non-profit and community organizations as part of our COASTAL Commitment initiative. Together we are helping tackle some of our communities’ pressing health and social needs.

**Position Summary**:
Interviews patient or patients’ representative to obtain necessary personal, financial, and demographic information. Prepares patient record and inputs into computer. Obtains and verifies insurance coverage. Completes and obtains signatures on required forms. Collects co-payments, deductibles, and other cash payments as needed. Balances daily payment sheets. Routes patient demographics to pertinent departments. Demonstrates extraordinary commitment to excellence by adhering to department excellence criteria.

**Major Position Responsibilities**:
The position characteristics reflect the most important duties, responsibilities and competencies considered necessary to perform the essential functions of the job in a fully competent manner. They should not be considered as a detailed description of all the work requirements of the position. The characteristics of the position and standards of performance may be changed by TCMC with or without prior notice based on the needs of the organization.
- Maintains a safe, clean working environment, including unit based safety and infection control requirements.
- Maintains excellent interpersonal skills in dealing with co-workers, TCMC staff, patients, physicians, and the public.
- Interviews patient or representative and enters complete information into the computer. Obtains all pertinent signatures, insurance information, and financial data to protect the hospital’s financial reimbursement.
- Performs special assigned duties to meet the needs of the department.
- Assumes cashiering responsibilities after hours and weekends.
- Verifies insurance eligibility and benefits within a timeframe determined by TCMC and obtains pre-authorizations from third-party payers in accordance with payer requirements.
- Verifies medical necessity in accordance with Centers for Medicare & Medicaid Services (CMS) standards and communicates relevant coverage/eligibility information to the patient.
- Verifies insurance eligibility, benefits, and authorization. Notifies patient of any deposits/deductibles needed prior to registration.
- Obtains estimates for procedure cost upon patients request.
- Assures that the patient is appropriate to withstand routine registration procedures; is escorted to the proper service area; and has had their questions and concerns answered.

**Qualifications**:

- One (1) year computer data entry experience, required.
- One (1) year customer service experience working with patients or customers, required.
- One (1) year healthcare insurance verification, preferred.
- Knowledge of medical terminology, preferred.

**Education**:

- High school diploma or GED, required.
- Salary/Hourly Wage range based on experience.

To protect the health of patients and staff, and to comply with the new State of California mandates, all job offers are contingent on the successful engagement in the TCMC COVID-19 vaccination program (fully vaccinated with documented proof or approved exception/deferral.)

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