Patient Access Rep

Overview:

The Patient Access Representative is responsible for the verification and collection of patient demographic and insurance information by direct data entry to the electronic medical record during the scheduling/pre-admit or admission process prior to discharge. S/he conducts an interview with the patient or authorized representative to secure information specific to requested services; accurately documenting the discussion and other registration/scheduling activities in the encounter.

Responsibilities:

Patient Registration and Scheduling

• Demonstrates ability to navigate web-based products or system applications required for registration or scheduling.

• Accurate identification of patient for direct data entry of required clinical, demographic, and insurance information to the electronic medical record during registration or for appointment booking of assigned diagnostic procedures.

• Provides general explanation of scheduled procedures and patient instructions that are necessary for conducting diagnostic medical services.
• Ensures system documentation specific to the patient visit is entered and accurately reflects activities related to patient or provider contact, order documentation, insurance verification, financial education, and payment.
• Provides explanation of legal forms and secures signature of patient/authorized party as required for services.
• Demonstrates basic understanding of compliance standards required within a healthcare environment including EMTALA and HIPAA-Privacy Patient Confidentiality regulations.

Insurance Verification

• Accurate identification and selection of insurance carrier in the patient medical record for specified dates of medical services.

• Navigation of web-based products or system applications to initiate and document insurance eligibility, benefit details, and authorization requirements.

• Performs required notifications to ensure insurance authorization for identified medical services, surgical procedures, and inpatient/observation stays are secured and documented.
• Demonstrates basic knowledge of CPT and ICD10 diagnosis coding documentation as required for medical services.

Financial Counseling

• Demonstrates basic knowledge of regulatory or Third Party Payer insurance requirements including Medicare, AHCCCS/Medicaid, Workers Comp and other commercial payers.

• Educates the patient on insurance eligibility, coverage, and availability of medical financial assistance program(s).

• Collects identified patient financial liabilities; performs secured payment entry and deposit/cash reconciliation steps.

Revenue Cycle Support

• Performs PBX Switchboard functions as required for answering and routing of internal/external calls; paging codes and fire alarms; handles department call volumes as assigned to appropriately respond to requests from patients, providers, or other hospital departments.

• Acts as a resource for clinical departments for registration/scheduled services related to data entry of patient account fields, provider order requirements, and questions regarding insurance coverage or financial assistance.

Compliance/Safety

• Responsible for reporting any safety-related incident in a timely fashion through the Midas/RDE tool; attends all safety-related training programs; performs work in a safe manner; monitors work environment for possible safety issues and ensures others are also performing work in a safe manner.

• Stays current and complies with state and federal regulations/statutes and company policies that impact the employee's area of responsibility.

• If required for the position, ensures all certifications and/or licenses are up-to-date and valid prior to expiration dates.
• Completes all company mandatory modules and required job-specific training in the specified time frame.

Qualifications:

Education

High School Diploma or GED- Required

Medical Terminology Coursework- Preferred

Experience

1 year in a customer service role- Required

Proficiency in Microsoft Applications (Excel, Word, PowerPoint)- Preferred

2 years experience in a medical facility, health insurance, or related medical field- Preferred

Healthcare is a rapidly changing environment and technology is integrated into almost all aspects of patient care. Computers and other electronic devices are utilized across the organization and throughout each department. Colleagues must have an understanding of computers, and competence in using computers and basic software programs.