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Senior Patient Access Representative
2 months ago
As a Patient Access Lead at Optum, you will play a critical role in ensuring the smooth operation of our healthcare services. Your primary responsibility will be to organize and manage the daily activities and paperwork of our practice, serving as the first point of contact for patients and healthcare providers.
Key Responsibilities- Maintain up-to-date knowledge of registration requirements for various areas, including main admitting, OP registration, ED registration, maternity, and rehabilitation units.
- Ensure accurate and timely entry of demographic information into the ADT system.
- Properly identify patients to prevent duplicate medical record numbers.
- Review assigned accounts for accuracy and completeness, obtaining required documentation as needed.
- Meet CMS billing requirements for MSP, Important Message from Medicare, Observation Notice, and other regulatory requirements.
- Collect and enter required data into the ADT system, emphasizing accuracy of demographic and financial information for proper reimbursement.
- Review pre-registered accounts, verifying information with patients and correcting errors.
- Obtain patient/guarantor signatures for required forms.
- Ensure all required documents are scanned into the appropriate system.
- Provide patients with necessary printed materials, including Patient Rights and Responsibilities, HIPAA Privacy Act notification, and Advance Directive.
- Follow downtime procedures, manually entering patient information and identifying patient MRNs in the MPI database.
- Follow EMTALA-compliant registration steps for Emergency Department and Labor and Delivery areas.
- Assess self-pay patients for presumptive eligibility and initiate the process when necessary.
- Monitor and address tasks associated with the Mede/Analytics PAI tool.
- Follow approved scripting and verify insurance benefits using electronic verification systems or contacting payers directly.
- Thoroughly document insurance verification information in the ADT system, including deductibles, copayments, coinsurance, and policy limitations.
- Obtain referral, authorization, and pre-certification information, documenting this in the ADT system and submitting notices of admission when necessary.
- Verify medical necessity checks for outpatient services and complete checks when necessary.
- Verify patient liabilities with payers, calculate payments, and request payment at registration.
- Identify outstanding balances due from previous visits, notify patients, and request payment.
- Set up payment plans for patients unable to pay their entire current copayment and/or past balance in one payment.
- Document conversations with patients regarding financial liabilities and payment agreements.
- Apply payments to patient accounts and provide receipts when collecting payments.
- Clarify division of financial responsibility for services split between medical groups and insurance companies, documenting this in the ADT system.
- Escalate accounts to Patient Registration leadership staff when necessary, based on verification outcomes and patient ability to pay.
At Optum, we offer a comprehensive benefits package, competitive base pay, and opportunities for professional growth and development. Our team is dedicated to delivering exceptional patient care and improving health outcomes. If you are passionate about healthcare and committed to excellence, we encourage you to apply for this role.
