Patient Access Associate-Scheduling/Registration Services

Overview:
The Patient Access Associate is responsible for obtaining accurate and thorough demographic and financial information for each patient visit. Ensures that appropriate signatures, financial information, and precertification requirements are secured. Screens for benefit eligibility on appropriate accounts. Informs/educates patients that have not been pre-registered of their financial responsibility reviewing deductibles, coinsurance, allowable and copayments. An estimate is developed and reviewed with each patient. Collection process is initiated and posted to the patient’s account.

When these functions are completed with accuracy this process will ensure patient safety through appropriate identification, maximum reimbursement for hospital charges and compliance with all state and federal regulations.

Interacts in a customer focused and compassionate manner to ensure patients and their representative’s needs are met, and that they understand the medical center’s policies for the resolution of patient financial liabilities and the various available payment options.

Responsibilities:
Essential Functions/Responsibilities:

Essential functions are the duties and responsibilities that are essential to the position (not a task list). Do not include if less than 5% of work time is spent on this duty. Be specific without giving explicit instructions on how to perform the task. Do not include duties that are to be performed in the future. Duties should be action oriented and avoid vague or general statements.

% of Time

(annually)

Customer Service/Key Accountability

· Accurately and thoroughly collects, analyzes and records demographic, insurance/financial and clinical data in computer system. Ensures information source is appropriate.

· Updates and edits information in computer, ensuring that all fields are populated correctly and appropriately.

· Completes eligibility check and obtain benefits though electronic means or via phone contact with insurance carriers or other agencies.

· Contacts patients/families/physicians to obtain additional demographic/insurance information and update in computer system if needed to proceed with verification process.

· Interpret physicians’ hand-carried orders to determine service needs and scans physician orders or verifies that complete and valid orders are on file for each patient.

· Obtains information and completes MSPQ and other payer-specific documents.

· Reviews and explains all registration forms prior to obtaining signatures from patient or appropriate patient representative.

· Explain benefits and request copay, deductible and coinsurance as applicable after developing an estimate applying allowable (based on payer).

· Identifies prearranged payment commitment and follows instructions as outlined by the financial clearance department.

· Completes registration checklist.

· Ensure that all monies collected are posted to the correct patient account and are secure or turned over to appropriate associates/cash posting specialists. Provides receipt of payment.

· Balances cash drawer at the end of each shift to ensure cash, checks and payments made by credit card are accounted for and balance transactions.

· Meets defined / established collection goals of the health system.

· Identifies patients in financial hardship and refer to Patient Financial Coordinators/Certified Application Counselors for charity/financial assistance.

· Refers to Cash Posting Specialists requiring payment plans.

· Responsible for maintaining knowledge of EMTALA regulations and following these regulations.

· Remains aware of state (IA) and federal laws in regard to registration processes.

· Ensures each patient’s identification band is correct by asking the patient to review the information and initial the band and then assure it is securely fastened upon completion of this identification process.

· Ensures that medical necessity has been established when scheduled testing doesn’t meet requirements or that the patient signs a waiver of non-covered service prior to testing.

· Notify patients of need for Advanced Beneficiary Notice (ABN) for Medicare.

· Documents on accounts using hospital account note with activity comments to ensure easy account follow-up.

· Identifies payer requirements for preauthorization. If preauthorization not in place, contact Financial Clearance Department.

· Performs follow up visits to patients in nursing areas, ER treatment room or clinical departments to obtain additional registration information, documents and/or signatures. Follow-up may be performed via phone if appropriate to the situation (making sure a witness is present, if necessary).

· Participates in performance improvement initiatives and demonstrates initiative to improve quality and customer services with a goal to exceed customer expectations.

· Instrumental in training new Patient Access staff.

· Supervise volunteers and interns.

· Thoroughly performs responsibilities of the kiosk Promotor role including but not limited to coordinating and assisting patients for use of the kiosks where applicable.

Adhere to all confidentiality policies and procedures.

Answers telephone calls promptly and accurately. Takes telephone messages and directs calls in an appropriate and professional manner.

Retrieves, files, photocopies or scans medical correspondence, reports and miscellaneous items, as requested.

Integrates and demonstrates FOCUS values and Expectations for Personal and Service Excellence to guide professional behaviors, while adhering to the policies and procedures of IH-DM. Balance team and individual responsibilities; be open and objective to other’s views; give and welcome feedback; contribute to positive team goals; and put the success of the team above own interests.

· Arranges or assists with patient transport as necessary.

· Answers phones and routes calls as necessary.

· Maintains physician not in system master file as instructed and assigned.

· Monitors and maintains multiple work queues as instructed and assigned.

· Monitor tracking system and print orders and transcribe and scan into computer system.

· Work or shifts at any campus (Marion ER) could be a possibility for Patient Access roles.

85%

Billing Functions

· Refer patients who need financial assistance with their clinic/hospital bills to a Financial Advocate.

· Perform functions other than described due to extenuating circumstances.

· Other duties as assigned.

5%

Basic UPH Performance Criteria

· Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.

· Demonstrates ability to meet business needs of department with regular, reliable attendance.

· Employee maintains current licenses and/or certifications required for the position.

· Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.

· Completes all annual education and competency requirements within the calendar year.

· Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.

10%

Disclaimer: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that required of the employee. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.

Demonstration of UPH Values and Standards of Behaviors

Consistently demonstrates UnityPoint Health’s values in the performance of job duties and responsibilities

Foster Unity:

· Leverage the skills and abilities of each person to enable great teams.

· Collaborate across departments, facilities, business units and regions.

· Seek to understand and are open to diverse thoughts and perspectives.

Own The Moment:

· Connect with each person treating them with courtesy, compassion, empathy, and respect.

· Enthusiastically engage in our work.

· Accountable for our individual actions and our team performance.

· Responsible for solving problems regardless of the origin.

Champion Excellence:

· Commit to the best outcomes and highest quality.

· Have a relentless focus on exceeding expectations.

· Believe in sharing our results, learning from our mistakes, and celebrating our successes.

Seize Opportunities:

· Embrace and promote innovation and transformation.

· Create partnerships that improve care delivery in our communities.

· Have the courage to challenge the status quo.

Qualifications:

QUALIFICATIONS:

Minimum Requirements

Identify items that are minimally required to perform the essential functions of this position.

Preferred or Specialized

Not required to perform the essential functions of the position.

Education:

High school graduate or GED equivalent is required

Prefer candidates who have Patient Access experience or Associate’s Degree.

Experience:

Prior Customer service experience is required.

· Two years of experience in a hospital patient access/patient accounts department, medical office/clinic, or insurance company.

· Experience interacting with patients and a working knowledge of third-party payers.

· Experience conducting financial conversations requesting payment for services.

· Prior experience with verification and payer benefit and eligibility systems.

· Knowledge of medical terminology.

License(s)/Certification(s):

Valid driver’s license when driving any vehicle for work-related reasons.

Knowledge/Skills/Abilities:

Technical aptitude – ability to learn new systems quickly

Data entry

Communication – both written and verbal

Customer/Patient focused

Interpersonal skills

Managing priorities

Multicultural sensitivity

Planning/organizing skills

Problem solving

Professionalism

Teamwork

· Flexibility of schedule.

· EPIC

Other:

Use of usual and customary equipment used to perform essential functions of the position.

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