Patient Access Representative

4 weeks ago

Monroe, United States Franciscan Missionaries of Our Lady Health System Full time
Job Description

The Patient Access Representative 1 - ED (PAR 1) is responsible for accurately registering patients presenting to the Emergency Department, including traumas, stroke patients, disaster response patients, other emergency patients, behavioral health, direct admits to inpatient units, surgery patients, radiology patients, and prisoners. Registration includes validating patient identity, collecting ED-specific screening information, coordinating with ED nurses to ensure patients are triaged in a timely manner, verification of insurance coverage, calculation of and collection of patient co-insurance/deductibles/co-pays, determination of in-network and out-of-network status post-stabilization, and balancing of cash. In this fast-paced, high-stress environment, the PAR1 demonstrates professional/effective communication skills with patients and families, physicians, and nurses. They manage patient and visitor concerns during traumas and disasters. The PAR1 is knowledgeable of and compliant with federal and state regulations related to acute-care patient registration, with special emphasis on EMTALA regulations and the No Surprises Act. Team members in the ED must be flexible to change and have an ability to adapt and adjust to a constantly changing environment. Must be able to respond to disaster activation with plans to work on-site until conclusion of activation.

Responsibilities

  1. Registration
    1. Effectively meets customer needs, builds productive customer relationships, and takes responsibility for customer satisfaction and loyalty. Represents the Patient Access department in a professional, courteous manner at ALL times. Asks patients if they may have special needs. Calls patients by name, Greets patients in a courteous and professional manner. Prioritizes and completes registration in a consistent, courteous, professional, accurate and timely manner.
      1. Accurately identify patients that present to the ER without proof of legal identification (Identification card, Driver's license, Passport, etc.) due to EMTALA regulations
    2. Obtains necessary information from patient, including demographic information, insurance, guarantor, and correctly inputs it into registration software. If patient is already in the system, finds correct patient record and verifies information in the system.
    3. Uses critical thinking skills to evaluate each registration situation to ensure customized registration experience based on individual patient circumstances. Uses knowledge of federal and state laws (EMTALA, HIPAA, Balanced Billing Act, Participating Provider statute, HITECH law, worker's compensation regulations, victims of sexually oriented criminal offenses regulation, 2 midnight rules, ABN's, Patient status requirements, MSPs, and state regulations on notification of out-of-network status) to ensure compliant registration
      1. Managing the special needs of patients/ family members and visitors during active traumatic situations and disaster events
      2. Coordinate registration intake of trauma, stroke and heart alerts to ensure timely triage
    4. Ensures each patient is assigned only one medical record number.
    5. Communicates the purpose of and obtains patient/legal guardian signatures on all necessary hospital documents such as Hospital consent forms, assignment of benefits, patient rights, etc.
    6. Extensively documents each encounter in account notes to ensure successful cross-function communication.
    7. Ensures orders are received and are consistent with tests/procedures.
    8. Monitors the waiting room, facilitates patient flow, and resolves issues regarding orders or missing/conflicting information, to ensure timely and accurate patient registration.
      1. Effectively communicate with patient, family, visitors, EMS, RNs and providers simultaneously
  2. Insurance and Benefits Knowledge
    1. Demonstrates knowledge of insurance plans, including understanding of varying payer rules and requirements related to insurance coverage
    2. Verifies eligibility (utilizing online eligibility software tools whenever possible) and obtains necessary authorizations for services rendered.
    3. Selects correct insurance plans in the registration software, in the correct order (primary versus secondary).
    4. Has understanding of required forms (including Medicare Secondary Payer Questionnaire) and has ability to explain them to the patient.
    5. Utilizes payment estimator software to calculate patient financial responsibility. Uses critical thinking skills to determine correct data input during the estimate process and to verify accuracy of output.
    6. Determines when patients may be eligible for financial assistance and directs patients to appropriate resources.
  3. Financial Collections
    1. Uses proven customer service techniques and scripting to collect the patient financial obligation, at or before the time of service. Negotiates with patient to ensure a deposit is collected, in accordance with corporate policy and procedure.
    2. Understands and explains the details of the out-of-pocket calculation.
      1. Expectation to collect out-of-pocket responsibility at patient bedside without prior benefit information prior to service while navigating around patient care team
    3. Analyzes documentation/notes on current and previous accounts in order to explain balances to the patient.
    4. Demonstrates knowledge and ability to complete account acknowledgement forms when appropriate.
    5. Collects cash, prints receipts, and balances cash drawers.
  4. Other Duties as Assigned
    1. Performs all other duties as assigned.


Qualifications

Experience: 1 year customer service experience or related certification (e.g. Certified Coder, Certified Medical Assistant)

Education: High School diploma or equivalent

Special Skills: Advanced clerical and computer skills, critical thinking skills, ability to work in high-stress situations, professional
appearance and behavior, good communication skills, dependability, flexibility, teamwork.

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