Patient Access Representative I
1 day ago
The Patient Access Representative I is a key role within the Kaiser Permanente Health System environment. This position is responsible for ensuring a complete and accurate patient admission/registration process. The ideal candidate will have excellent communication skills, organizational abilities, and a strong understanding of healthcare regulations and policies.
Responsibilities:
Registration:
Greets and registers patients for various medical services in a hospital setting, potentially in a 24-hour, 7-day environment. Pre-registers patients where applicable and completes comprehensive bedside or telephone interviews to obtain pertinent demographic information, insurance data, and third-party liability information.
Performs minimal eligibility verification, resolves discrepancies, and identifies the need for financial assistance recommendations and applications. Refers patients to Financial Counselors as necessary.
Verifies patient demographic and insurance information with the patient, consistent with CMS regulations, National Registration Standards, and regional policies.
Uses problem-solving skills to verify patient identification through patient name, spouse names, SSN, DOB, and address to minimize duplicate medical records.
Interviews patients to determine appropriate insurance carriers and identifies, verifies, and inputs Other Coverage Information (OCI), primary, secondary, and tertiary payers for services provided.
Performs registration functions for all patient classes and clinical services.Revenue Collection:
Determines and collects cost-shares and partial payments for services to be received. Enters/verifies payments in the computer, closes cash drawers, counts currency, checks, and credit card payments at the end of each shift, and creates deposits per cash handling policies. Provides patient liability information and collects point-of-service cash from patients based on guidelines and/or systems provided by the department, including co-payments, deductibles, co-insurance, deposits, and outstanding balances. Communicates to patients the Kaiser Permanente policy on payment of services or prepayment when significant patient liabilities are identified. Refers patients to Financial Counselors as necessary. Interacts with Patient Business Services/Membership Services personnel regarding account status as necessary to respond to questions/concerns related to registration requirements. Documents all activity pertaining to patient accounts in the system.
Appointing:
Makes and/or cancels appointments based on member needs and regional protocol. If applicable, makes return appointments.
Regulatory/Organizational Compliance:
Completes regulatory or policy-required forms, including payor requirements such as Medicare, L & I requirements, and some commercial payors. Obtains all necessary signatures via mail, pre-admit, pre-op visit, or upon admission/registration.
Makes copies of patient identification, insurance information, and other related forms and documents, electronically scanning and capturing where appropriate. Understands and adheres to rules and regulations of Medicare, Medicaid, Managed Care, and Commercial payers regarding referrals, preauthorization, and pre-certification requirements. Is knowledgeable and maintains compliance with CMS by accurately completing Medicare Secondary Payer screening information to determine primary payor. Receives physician orders and, if applicable, performs medical necessity checks using automated systems. Interprets basic healthcare systems regulations and policies for patients and patient families consistent with the defined scope of work. Maintains an understanding of HIPAA privacy and security regulations with respect to patient confidentiality and regulations governing system use for patient registration requirements. Understands and adheres to EMTALA regulations and the relevance for patient registration and patient liability collection in the Emergency Department.General Services:
Stocks appropriate forms and supplies, takes out used supplies, and demonstrates responsibility in handling supplies and equipment in a cost-effective manner and according to standards such as policies, procedures, and infection control guidelines. Assists patients by providing specialty phone numbers, facility directions, and office layouts; directing to other departments and administrative services for further information, such as Membership Services, Dental, and Pharmacy. Escorts patients to areas of service, initiates safekeeping and return of patient valuables in accordance with hospital policy when required, and provides information assistance to patients, visitors, and the public regarding general hospital policies and procedures. Interacts with patients' physicians regarding status of hospital accounts/registration issues and refers as needed. Provides patients' demographic information/insurance plan updates to physician offices or other medical services, such as EMT services, where appropriate. Responsible for maintaining records during system downtime and performs recovery processes. Maintains accurate statistical records of departmental activities as needed, for data gathering within the UBT work teams. Performs all other duties as assigned consistent with job description.
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