Patient Access Representative

I Accountability Objectives:

      Responsible for performing the Patient Access process, completing accurate registration and pre-registration process

      and insurance verification for eligibility, scheduling for various departments procedures/appointments, entering patient

      data for services for departments participating in PHS (Pathways Healthcare Scheduling), coordinating multiple

      services in proper sequence, and informing patient/doctor's office as to preparations and insurance requirements for each

       service.  Collaborates with multiple departments to best utilize equipment and facilities, while accommodating

      physician preference and patient needs. Displays a courteous, professional manner, proactively developing customer

      relationships and giving high priority to customer satisfaction.

   II Position Qualifications:

   Minimum Education, Licensure / Certification and Experience Required.

   A.      Education

High school diploma or GED or equivalent required.

Courses in word processing and medical terminology preferred.

College classes in a business, public relations, or medical field concentration preferred.

   B.      Licensure / Certification

National Association of Healthcare Access Management certification preferred within one year of start date,

and maintains certifications.

   C       Special Skill / Aptitudes

Ability to type 30 wpm and familiarity with computer systems and applications required.

Ability to pass the basic medical terminology test with a passing grade.

Completion of Patient Management Registration Course and Pathways Healthcare Scheduling Course with at

least an 85% grade on the final exams prior to receiving access codes within 90 days of start date.

Strong interpersonal skills necessary to provide scheduling and registering patients and to clearly

communicate with a variety of customers of all ages and cultures.

Ability to work independently, organize tasks, problem solve, and devise acceptable solutions in a fast paced

work environment.

Ability to simultaneously gather verbal information through the use of the telephone and enter data into an

on-line computer terminal.

Excellent customer service orientation  skills necessary in order to deal effectively with various levels of

hospital personnel, outside customers and community groups.

   II Position Qualifications:

   Minimum Education, Licensure / Certification and Experience Required.

   D.      Experience

One year work experience related to patient registration, insurance verification, and/or medical terminology

required, normally gained by working in a hospital or physician's office setting including customer

interaction service OR

months emergency services experience related to patient registration, insurance verification, and/or medical

terminology required.

One year experience with ICD-9-CM and CPT coding as a Registrar or Patient Access Professional preferred.

   III Duties / Responsibilities:

Interviews the patient / family for admission and outpatient registration by entering the appropriate required

information on-line. This will include, but is not limited to: demographics, clinical, and detailed insurance

information

Performs insurance eligibility verification by phone or on the Internet.

Independently schedules procedures for all departments and any subsequent departments added to Pathways,

utilizing individual departmental grids, resources and guidelines.

Determines if authorization is required for the patient's service and secures authorization for

treatment/procedures prior to service being rendered.

Determines an understanding of hospital policies, prevailing regulatory and third party requirements (MSP

questionnaire, pre-certification process, consent forms, etc.)

Recognizes and problem solves conflicts associated with time requests, resources, equipment or staff for each

department.

Coordinates multiple hospital services such as surgical procedures, ancillary testing, etc., in proper sequence

and according to the rules of the system, which may include managed care requirements and clinical

standards.

Refer patients with no insurance or outstanding balances to the Financial Counselor.

Informs patients or doctors' offices of preparations for appointments made.

Works independently to problem solve scheduling issues and troubleshoot/report system problems.

Maintain uninterrupted scheduling service utilizing down-time procedures.

Provides daily reports or printouts as directed while maintaining the confidentiality of patient records and

information at all times.

Utilizes excellent customer service and telephone courtesy skills in all interactions with customers.

Attends meetings, participates in Continuous Quality Improvement.

May perform clerical tasks specific to supporting an assigned department(s)  i.e., receptionist duties, charge

capture, report processing and delivering, copying, filing, etc.

Performs other duties as assigned.

Demonstrates and actively promotes an understanding and commitment to the mission of St. Joseph Mercy

Oakland through performing behaviors consistent with the Trinity Health Values.

Maintains a working knowledge of applicable Federal, State, and Local laws and regulations, the Trinity

Health Organizational Integrity Program, including the Standards of Conduct, Code of Ethics, as well as

other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and

professional behaviors.

Supports and conducts one's self in a manner consistent with customer service expectations.

In accordance with unit or departmental practice, determines that appropriate charges have been entered for the

correct patient, encounter, date/time of service, with any required modifiers.  Make corrections as needed per

charge capture policy/practice.

In accordance with unit or departmental practice, actively participates in on-going education and

communication regarding revenue management.

In accordance with unit or departmental practice, assists with tracking and monitoring of equipment assigned

to the unit.  Requests services for maintaining equipment as needed.

In accordance with unit or departmental practice, proficient with the electronic health records for

documentation, assessment, and care management, performing these activities concurrently with provision of

care throughout the shift.

   IV Dept/Unit Specific:

      Not Applicable

   V Working Conditions:

     
• Requires ability to sit up to 100% of time using a computer terminal, typing, and answering phones.

     
• Working weekends and holidays as necessary to meet staffing needs.  Work on different shifts may be

assigned as necessary to meet staffing requirements.  May be required to work overtime.

     
• Normal office environment.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.