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Patient Access Operations Lead
2 months ago
Overview
The Lead Patient Access Representative plays a crucial role in supporting the training and development of new personnel within the department, focusing on registration, scheduling, and financial processes for patients. Under the guidance of the Supervisor or Manager, this position also provides essential support during staffing shortages across various shifts, ensuring seamless operations within the department. This role serves as a knowledgeable resource, facilitating communication with clinical areas regarding patient access matters 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, adeptly navigating web-based systems essential for Patient Access Services.
Utilizes effective search methodologies to accurately enter clinical, demographic, and insurance information into the electronic medical record.
Provides comprehensive explanations of scheduled procedures and pertinent patient instructions related to medical services.
Ensures compliance with documentation standards specific to patient visits, accurately reflecting interactions with patients or providers, order documentation, and financial education.
Explains legal forms to patients, securing necessary signatures from patients or authorized representatives as required.
Demonstrates a thorough understanding of compliance standards in healthcare, including EMTALA and HIPAA regulations concerning patient confidentiality.
Eligibility and Authorization Management
* Identifies and selects the appropriate insurance carrier for patients within their medical records for specific service dates.
Utilizes web-based applications to initiate and document insurance eligibility, benefits, and authorization requirements.
Conducts necessary notifications to secure and document insurance authorizations for medical services, including surgical and inpatient procedures.
Possesses advanced knowledge of CPT and ICD10 coding, as well as physician order documentation necessary for medical services and medical necessity determinations.
Financial Counseling
* Demonstrates expert knowledge of regulatory requirements and Third Party Payer insurance policies, including Medicare and Medicaid.
Educates patients regarding insurance eligibility, coverage options, procedure costs, and available financial assistance resources.
Identifies and collects patient financial responsibilities, ensuring secure payment processing and cash reconciliation.
Utilizes web-based tools to provide charge estimates for various medical services based on patient inquiries or financial counseling needs.
Resolves issues related to scheduling, registration, or financial assistance applications on behalf of patients.
Monitors system work lists to follow up on financial counseling for patients in emergency and inpatient settings, ensuring accounts reflect updated payer information.
Revenue Cycle Support
* Assists management in reviewing and analyzing Revenue Cycle reports and work lists for encounter audits, assessing performance and accuracy of registration and scheduling activities.
Trains staff on essential Patient Access functions and workflows as assigned.
Identifies ongoing educational needs for staff to enhance performance, contributing to the development of training materials and presentations.
Acts as a resource for clinical departments regarding patient account data entry, provider order requirements, and inquiries about insurance coverage or financial assistance.
Supports management in preparing departmental operational reports, providing feedback on performance issues and recommending action plans for improvement.
Compliance and Safety
* Responsible for promptly reporting safety incidents through established channels; participates in safety training programs and maintains a safe work environment.
Ensures compliance with relevant state and federal regulations and company policies affecting the role.
Maintains up-to-date certifications and licenses as required for the position.
Completes all mandatory training and job-specific modules within designated timeframes.
Qualifications
Education
High School Diploma or GED - Required
Medical Terminology - Preferred
Associate's Degree - Preferred
Experience
Minimum of 2 years in Patient Services or related Revenue Cycle roles - Required
Proficiency in Microsoft Applications (Excel, Word, PowerPoint) - Required
Minimum of 3 years in a medical facility, health insurance, or related field - Preferred
The healthcare environment is continuously evolving, with technology integrated into patient care. Proficiency in computer usage and basic software applications is essential for all colleagues.
