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Patient Access Rep I COND

3 months ago

Libertyville, United States Advocate Health Full time
Major Responsibilities:
  • Accurately collects and analyzes all required demographic, insurance/financial, and clinical data necessary to register/admit patients from all payer classes.
    • 1)Recognizes communication obstacles for patients with loss of hearing and/or sight, and those that have trouble in reading, writing and understanding the English language. Responds appropriately to patients' communication needs, secures interpreter or other necessary assistance to ensure customer comprehension.
    • 2)Using approved identification standards, positively identifies the patient and ensures assignment of a unique medical record number and appropriate banding.
    • 3)Collects and records accurate and thorough patient, guarantor, insured and insurance information when registering patients' accounts.
    • 4)Interprets and validates physician orders for service, uses appropriate accommodation and service codes; and establishes account parameters to ensure revenue is properly recorded and accurate bills are produced.
    • 5)Using insurance eligibility software, validates demographic information and assures patients are eligible for service provided.
    • 6)Appropriately explains, secures, and witnesses all signatures required to provide medical treatment, assign insurance benefits, release information, establish financial responsibility and meet other internal regulatory, or payer requirements.
    • 7)Completes the Medicare Questionnaire for all Medicare patients, ensures inpatients receive the important Medicare Message document.
    • 8)Understands and follows all government, managed care and commercial insurance plan rules as they relate to patient access; and ensures accounts are in order for timely billing and collection.
    • 9)Accurately generates, assembles and processes all required forms, documents and reports including face sheets, labels, and wristbands, medical record forms, and other special documents. Produces and distributes these on a timely basis to both internal and external parties.
    • 10)Analyzes and records data and processes transactions to ensure that an accurate historical patient data base is maintained for each registration encounter.
  • Performs revenue cycle activities that prevent payment denials, increase cash collections and assures appropriate financial disposition of account balances.
    • 1)Initiates electronic and/or telephone inquires to insurance payers/claim administrators. Provides information and secures responses that confirm eligibility for the third-party benefits and the level of benefits available.
    • 2)Identifies and obtains needed authorizations, referrals and service approvals from physicians, insurance companies and/or medical management companies.
    • 3)Explains to patients their insurance benefits, self pay balances and provides information to ensure they understand the policies that govern the revenue cycle and the processes that will be followed.
    • 4)Explains various payment options to the patient or responsible party and negotiates acceptable resolution of expected self pay balances.
    • 5)Explains the charity care process and provides application packet. Updates system to record charity application was given to patient/responsible party.
    • 6)Using compliance checker software, screens physician orders against medical necessity criteria. Follows procedures related to obtaining additional diagnosis from physicians and initiating the Medicare Advance Beneficiary Notice of Non-Coverage to patients.
    • 7)Reviews and analyzes records of active patients to identify and resolve situations where future care is different than originally identified, including re-verification of insurance coverage, recertification of payer requirements, and recalculation of patient liabilities.
    • 8)Requests and accepts payments, generates receipts for funds received and maintains necessary records of payment transactions. Utilizes automated systems to process credit and debit card transactions.
    • 9)Ensures payments are secured; and deposits and cash drawers are balanced and turned over to appropriate associates.
  • Performs department general clerical and support duties..
    • 1)Receives, properly responds to, or redirects telephone, electronic, and in-person inquiries from patients, payers, physician and their staff, internal departments, external organizations and other persons or entities. Obtains, receives and documents accurate and thorough information when taking messages.
    • 2)Accurately records and ensures patients are entered into the patient tracking systems. Takes action to ensure patient waiting and turnaround time is not excessive and meets department goals. Notifies Coordinators/Manager or documents events and responses when patient volume exceeds staff resources.
    • 3)Assists Pre Access staff by completing reminder calls and naming faxes.
    • 4)Monitors and maintains various work queues and issue reports, and/or performs special projects as assigned.
    • 5)Contacts physicians to obtain and clarify orders. Performs follow-up of verbal orders. Insures benefit authorization/notification for orders changed on the day of service.
    • 6)Assumes patient admission and bed control responsibilities including inpatient bed coordination.
    • 7)Utilizes account notes appropriately. Identifies and records information that needs explanation.
    • 8)May perform order entry or service area specific responsibilities as required. May vary per registration area.
  • Exhibits excellent customer service behaviors specific to point of service registration.
    • 1)Greets patients using patient name.
    • 2)Consistantly follows AIDET, acknowledging patient, introducing self, explaining registration process and approximate time to complete and thank patient for using Condell.
    • 3)Closes office door or speaks in softly in open area to preserve patient privacy.
    • 4)Asks patient what else you can do for them at end of registration process.
    • 5)Resolve patient concerns or seek assistance to resolve patient concerns.
    • 6)Performs all other duties as assigned.


Education/Experience Required:
  • IHS diploma or equivalent. Experience handling money. Prefers 2-3 years related experience in a healthcare setting (revenue cycle experience preferred) hospital, physician office or insurance company. Applicable education may be substituted.


Knowledge, Skills & Abilities Required:
  • Successful completion of a data entry assessment Effective organizational and prioritization skills Exhibits sophisticated interviewing, communication and negotiation skills. Possesses intermediate math and business writing skills Knowledge of office equipment Computer literate Demonstrated customer service skills. Must be able make change and count a cash drawer.
  • MN/A


Physicial Requirements and Working Conditions:
  • Ability to work in a fast-paced environment with established time constraints and emotional and sensitive situations. Employee is regularly required to sit, stand, walk, talk and hear. Must possess visual acuity and manual dexterity to perform computer data entry and other clerical aspects of the job. May bend, stoop, twist and reach in conjunction with the job requirements. May lift files, reference books, supplies, and other documents up to 10 lbs. May walk and push a wheeled cart with a computer and supplies weighing up to 50 lbs. This is both a sedentary and active position. Employee is regularly exposed to noise associated with working around others in an office setting. May be exposed to a variety of illness and medical conditions. Must be able and willing to work weekends, holidays and occasionally other shifts. Must be able and willing to rotate work environments, ED, OP/ADM, Rover, Check-In, Phone Desk, etc. May need to work shifts at off-site locations.
  • If position has direct patient care or direct patient contact the following lifting requirement supersedes any previous lifting requirement effective 06/01/2015. Ability to lift up to 35 pounds without assistance. For patient lifts of over 35 pounds, or when patient is unable to assist with the lift, patient handling equipment is expected to be used, with at least one other associate, when available. Unique patient lifting/movement situations will be assessed on a case-by-case basis.


This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.