Patient Access Representative
7 days ago
Perform general patient access and registration duties in EPIC Practice Management, such as, answer telephones, make appointments, process referrals, maintain provider templates and appointment schedules, verify patient demographics and insurance coverage. Perform general patient account management duties, such as obtain prior authorization for services, process items in the appropriate work queues to complete registration and enter service capture data. Ensure patient accounts and coverage structures meet Kaiser Permanente standards and billing requirements of various payors. Function as liaison to Patient Financial Services and the Health Plan. Communicate with external government payors and employers, as necessary. Work directly with patients on billing related matters and provide fee estimates to patients for Kaiser Permanente services. May perform duties related to cash collection and depositing. Demonstrate strong customer service and communication skills. Adhere to HIPAA and patient confidentiality requirements. May act as the patients first point of contact with Kaiser Permanente.
Essential Responsibilities:
- Patient Access and Registration: Answer phones; Perform appointment making processes; Complete accurate patient registration, such as verification of patient demographics and payor coverage; Perform check-in, check-out, admit and discharge tasks; Build and maintain appointing templates; Perform MyGH set up verification; Communicate with patients via multiple channels; Process internal and external referrals.
- General Account Management: Confirm and set up payor coverage structures; Obtain prior authorization for services; Process appropriate items in the patient, claim edit and charge review work queues; Act as liaison to Patient Financial Services and the Health Plan; Communicate with external government payors and employers, as necessary; Perform manual service capture and data entry; Act as liaison to Health Information Management Coding Specialist for facility specific coding issues; Apply account review criteria and billing guidelines in preparation for off site billing of professional services; Provide fee estimates for KP services; Assist patients with billing questions.
- Cash Collection and Depositing: Collect co-pays and cost shares for services; Process refunds; Perform daily cash reconciliation and reporting for retail transactions; Process daily till closeout; Prepare bank documentation, combine and reconcile deposits of cashiers in the facility.
- Customer Service: Adhere to Kaiser Permanente behavior & appearance standards; Demonstrate strong customer service and communication skills; Treat customers with courtesy and respect; Adhere to HIPAA and patient confidentiality requirements; May act as a guide when a patient accesses Kaiser Permanente services.
- Minimum one (1) year of experience in a business office within a medical care delivery, hospital, insurance or large contact center environment OR a minimum of two (2) years of experience providing excellent customer service in a fast- paced environment.
- Per the National Agreement, current KP Coalition employees have this experience requirement waived.
- High School Diploma OR General Education Development (GED) required.
- N/A
- Experience in electronic patient accounting, scheduling or customer information systems.
- Basic PC skills in MS Windows environment, 10-key and typing (35 WPM).
- Customer service skills, the ability to effectively communicate with a diverse customer base, and strong organizational skills.
- Three (3) years of additional experience in a patient care setting.
- Use of Epic Cadence/Prelude/Resolute or other patient scheduling and accounting systems.
- Understanding of Kaiser Permanente billing protocols and cash posting systems.
- Familiar with medical terminology.
- Knowledge of delivery system business operations processes, including appointing, account intake and verification, cashiering, financial interviewing, referral processing and data entry.
- Working knowledge of health care insurance practices and billing.
- Knowledge of health care payer/insurer types, including state and federal workers. compensation, commercial, subrogation, self-insured, Medicare (CMS) and Medicaid (DSHS).
- Understanding of Kaiser Permanente insurance products and benefits.
- Proven ability to establish credibility and respect with patients.
- Proven ability to problem solve and take initiative.
- Ability to provide feedback and education to other staff regarding correct procedures.
- Six (6) months experience in processing various types of billing, including workers compensation, subrogation, coordination of benefits, and private/self-pay.
- Demonstrate a high degree of adaptability, productivity, and reliability as well as an ability to work independently in an ambiguous environment.
- Effective interpersonal, communication, and customer service skills for both face-to-face and telephone interactions with patients, medical staff, and team members.
- Positive, open-minded, and focused on continuous improvement.
- Ability to learn new processes, procedures, and software programs quickly, while demonstrating attention to detail and accuracy in their daily work.
- Vocational training in medical office procedures and billing.
- Coursework or practical training and experience in ICD-9 and CPT coding.
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