Lead Representative for Patient Access Services

2 weeks ago

Flagstaff, Arizona, United States Northern Arizona Healthcare Full time

Overview

The Lead Patient Access Representative plays a crucial role in supporting the training of new personnel within the department, focusing on registration, scheduling, and financial activities for patients. Under the guidance of the Supervisor or Manager, this position also provides essential support during staffing shortages across all shifts, actively engaging as a key member of the department. This role serves as a knowledgeable resource, facilitating communication with clinical areas regarding patient access processes and escalating issues to management when necessary.

Key Responsibilities

Patient Registration and Scheduling
* Exhibits a high level of proficiency in computer skills and Microsoft applications, including navigating web-based systems essential for Patient Access Services.

Employs effective search methodologies and adheres to proper data entry protocols for clinical, demographic, and insurance information in electronic medical records.

Offers comprehensive explanations of scheduled procedures and provides necessary patient instructions related to medical services.

Ensures compliance with documentation requirements specific to patient visits, accurately reflecting interactions with patients or providers, order documentation, and financial education/payment processes.

Clarifies legal forms and secures valid signatures from patients or authorized representatives as required.

Demonstrates an understanding of compliance standards within healthcare, including regulations pertaining to patient confidentiality and safety.

Eligibility and Authorization Management
* Identifies and selects the appropriate insurance carrier for patients within their medical records for specified service dates.

Utilizes web-based applications to initiate and document insurance eligibility, benefits, and authorization requirements.

Ensures timely notifications to secure insurance authorizations for medical services, including surgical procedures and inpatient stays.

Possesses advanced knowledge of coding systems and documentation requirements necessary for determining medical necessity.

Financial Counseling
* Demonstrates expertise in understanding regulatory and Third Party Payer insurance requirements, including Medicare and Medicaid.

Educates patients on their insurance eligibility, coverage details, procedure costs, and available financial assistance resources.

Identifies and collects patient financial responsibilities, ensuring secure payment processing and accurate cash reconciliation.

Utilizes web-based tools to provide charge estimates for various medical services based on patient inquiries or financial counseling needs.

Addresses issues related to scheduling, registration, or financial assistance applications effectively.

On behalf of patients, liaises with providers and insurance representatives to facilitate the financial assistance application process.

Monitors work lists to ensure follow-up financial counseling for patients in emergency and inpatient settings, updating accounts as necessary.

Revenue Cycle Support
* Assists management in reviewing Revenue Cycle reports and conducting audits to assess the accuracy of registration and scheduling activities.

Trains staff on essential Patient Access functions and workflow processes as assigned.

Identifies ongoing educational needs of staff to enhance performance and contributes to the development of training materials and presentations.

Acts as a resource for clinical departments regarding patient account data entry, provider order requirements, and insurance inquiries.

Supports management in preparing operational reports, providing feedback on deficiencies, and recommending action plans for improvement.

Compliance and Safety
* Responsible for promptly reporting safety-related incidents and participating in safety training programs.

Ensures compliance with relevant state and federal regulations, as well as company policies impacting the role.

Maintains up-to-date certifications and licenses as required for the position.

Completes all mandatory training and job-specific modules within the designated timeframe.

Qualifications

Education
High School Diploma or GED is required; Medical Terminology and an Associate's Degree are preferred.

Experience
A minimum of 2 years in Patient Services or related Revenue Cycle roles is required, along with proficiency in Microsoft applications.

Preferred candidates will have at least 3 years of experience in a medical facility or related field.

As healthcare continues to evolve, proficiency in technology and computer systems is essential for all roles within the organization.

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