Lead Patient Access Representative
2 weeks ago
Overview:
The Patient Access Lead may provide support and assistance for internal department training of new staff for all registration, scheduling, and patient financial activities under direction of Supervisor/Manager. Provides support during staff shortages for all shifts and serves as an active working member of the assigned department area. Acts as an expert resource to coordinate and communicate with hospital or associated clinical area on issues related to the patient access process with escalation to management as appropriate.
**Responsibilities**:
**Patient Registration/Scheduling**
- Utilizes person search methodology and correct process for system data entry of required clinical, demographic, and insurance information to the electronic medical record.
- Provides detailed explanation of scheduled procedures or patient instructions associated to medical procedures.
- Complies with system documentation requirements specific to the patient visit to ensure data entry reflects activities related to patient or provider contact, order documentation, insurance, and financial education/payment.
- Provides explanation of legal forms, securing valid signature of patient/authorized party as required for services.
- Demonstrates ability to explain compliance standards required within a healthcare environment including EMTALA and HIPAA-Privacy Patient Confidentiality regulations.
**Eligibility/Authorization Management**
- Demonstrates ability to identify and select appropriate insurance carrier in the patient medical record for specified dates of medical services.
- Performs required notifications to ensure insurance authorization for identified medical services including surgical/special interventional procedures and inpatient/observation stays is secured and documented.
- Demonstrates advanced knowledge of CPT, ICD10 coding, and physician order documentation as required for medical services including determinations for medical necessity.
**Financial Counseling**
- Demonstrates expert knowledge of regulatory or Third Party Payer insurance requirements including Medicare, AHCCCS/Medicaid, Workers Comp and other commercial payers.
- Educates the patient on insurance eligibility, coverage, procedure costs, alternate resources for financial assistance, and payment arrangement guidelines.
- Ability to identify and collect patient financial liabilities and performs secured payment entry and deposit/cash reconciliation steps.
- Navigates web based products to initiate, document, and provide charge estimation for Inpatient/Observation stays, surgical/special interventional procedures or service categories based on patient requests or financial counseling needs.
- Monitors system work lists to provide necessary financial counseling follow up for private pay patients in the Emergency Department and Inpatient/Observation settings; ensures patient account is updated to reflect new payer source(s).
**Revenue Cycle Support**
- Assists Supervisor/Manager in review and analysis of Revenue Cycle reports or system work lists for encounter audits; determines performance levels and accuracy of information collected during registration/scheduling by staff member.
- Demonstrates ability to train staff on all Patient Access essential job functions and work flow processes as assigned.
- Assists Supervisor/Manager in identifying continued education needs of staff to improve performance levels; assists in development of training materials, job aids, or staff meeting presentations.
- Acts as an expert resource to clinical departments for registration/scheduled services related to data entry of patient account fields, provider order requirements, and questions regarding insurance coverage or financial assistance.
- Assists Supervisor/Manager in completing departmental operational reports; provides feedback on identified deficiencies and recommends and well as supports implementation of action plans for improvement.
**Compliance/Safety**
- Responsible for reporting any safety-related incident in a timely fashion through the Midas/RDE tool; attends all safety-related training programs; performs work in a safe manner; monitors work environment for possible safety issues and ensures others are also performing work in a safe manner.
- Stays current and complies with state and federal regulations/statutes and company policies that impact the employee's area of responsibility.
- If required for the position, ensures all certifications and/or licenses are up-to-date and valid prior to expiration dates.
- Completes all company mandatory modules and required job-specific training in the specified time frame.
Qualifications:
**Education**
High School Diploma or GED- Required
Medical Terminology
- Preferred
Associate's Degree
- Preferred
**Certification & Licensures**
**Experience**
Minimum 2 years experience in Patient Services or related Revenue Cycle job roles
- Required
Proficiency in Microsoft Applications (Excel, Word, PowerPoint)
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