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Patient Access Representative

7 months ago

Elkhart, United States Beacon Health System Full time

Summary

Reports to the Supervisor or Manager. Follows established Beacon policies and procedures to admit and register patients for services in a professional and courteous manner. Completes the pre-registration, registration, Completes insurance verification and must be able to accurately decipher eligibility responses and relay that information back to the patient. Document processes which involve communicating with patients and insurance companies. Collects applicable co-payments, deductibles, and obtains insurance information from the patient. Verifies insurance benefits, posts applicable co-payments, deductibles, and performs daily cash balancing procedures. Obtains all required signatures on paperwork and performs clerical duties as necessary.

MISSION, VALUES and SERVICE GOALS

MISSION: We deliver outstanding care, inspire health, and connect with heart. VALUES: Trust. Respect. Integrity. Compassion. SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.

Registration/Pre-Registration/Patient Check In

Effectively incorporates add on procedures in an efficient and timely manner. Enters patient name, arrival time, appointment time, procedure and any pertinent information into the Pager system to ensure the location of the patient is visible to everyone in the department. This allows collection of daily statistical date for quality assurance directly related to patient waiting times. Using PHS and the daily schedules, identifies both pre-registered and non pre-registered patients with appointments. Verifies patient demographics in PHS, prints/reviews check in itinerary for alerts, reviews orders for completeness and checks in pre-registered patients accurately and quickly. At the point of pre-registration identifies the next scheduled patient to call using the electronic call list. Accurately marks the patient in the call list indicating the pre-registration is complete or enters a time to call the patient back. At the point of registration obtains identification, demographic and insurance information and ensures the correct patient type, medical service, procedure and accommodation codes are entered into the hospital registration system. Verifies and updates all information as appropriate. Accurately identifies pre-registers patients for specific departments and completes pre-registration packets. Requests copies of the insurance card(s) and driver's license or other government picture ID to confirm the insurance and identification of the patient. Verifies the patient's insurance eligibility and obtains coverage information from the R1 insurance verification tool and uses the information to confirm the correct insurance plan was entered into STAR Navigator. Accurately identifies co-pays, co-insurance, and/or patient deductibles in the R1 insurance tool which includes entering the correct procedure and reading the notes entered that may identify partial payments agreed upon between the patient and financial counselor. Once payment is determined and entered into RevSpring, the registrar is responsible for generating a receipt of payment and entering payment information into the R1 tool. Checks Medicare Medical Necessity software prior to ordering outpatient testing and produces an ABN when appropriate. Completes the Medicare Secondary Payer Questionnaire to meet Medicare compliance guidelines. Provides the Important Message from Medicare form for all inpatient admissions who are insured by Medicare or a Medicare Replacement policy. Provides the Medicare Outpatient Observation Notice from Medicare for all observation admissions who are insured by Medicare or a Medicare Replacement policy. Prints orders from Care Ready as needed. Reviews physician orders for completeness to meet HIM guidelines and places orders for outpatient services in an accurate and timely manner. Assists patients in obtaining an order when one was not sent or requesting a complete order when needed. Documents that privacy notices are given to ensure HIPAA compliance. Protects patient confidentiality when handling orders and check in documents. Obtains signatures for the hospital consent to treat, privacy notices and all other necessary forms. Scans signature pages, insurance cards, photo ID and order into the electronic patient folder for ease of access and protection from identity theft. Uses double identifiers to accurately identify the patient before placing the hospital patient identification band on the patient.

Bed Control

Cheerfully handles all incoming phone calls and helps answers questions or directs the caller to the appropriate area. Routinely checks the bed control inbox and completes patient type changes in a timely manner. Converts pre-registered patient packets to the correct patient type at midnight on the day of procedure, ensures all of the documents are printed and finalizes the pre-registration packet for ease of check in when the patient arrives. Using established guidelines makes bed transfers and maintains a listing of daily admissions. Keeps a daily calendar of planned admissions and special accommodation requirements. Updates attending physicians for the hospitalist program accurately and in a timely manner as requested.

Order Management

Prints reports from PHS for next day scheduled outpatient procedures and produces a copy of the order from Care Ready or Cerner. Completes the order in Care Ready to preserve the integrity of the files and prevent wrong tests from being performed. Proactively checks the PHS schedule to ensure we have received orders for all next day scheduled outpatient procedures and faxes/phones the physician practice a request for any next day orders not yet received. Maintains orders alphabetically for easy retrieval at the point of patient check in. Processes reports from PHS to identify cancellations, no shows and rescheduled exams to ensure that scheduling information is continually updated and cancelled pre-registered accounts are processed in a timely manner. Faxes a request for new standing orders prior to the one year expiration date. Fields all incoming calls routed from the front desk to help trouble shoot issues with orders and patients.

Team Leader

Effectively helps to implement department policies & procedures and changes as needed. Acts as a positive role model during training, and contributes to the success of each trainee. Gives positive feedback and shows constructive ways to aid in the learning process. Continues to act as a mentor to help all staff succeed, especially new staff members. Takes pride in being a team leader, and shows the ability to work through problems in a positive way. Knowledgeable of all positions in the department and able to cover open positions when needed. Using Active Staffer schedules department staff ensuring equitable work and staff distribution and adjusts staffing to meet volume, to assure minimum overtime and use of people providing enough staff to meet the standard of service. Ensures that department meeting minutes are completed and emailed to the department in a timely manner. Follows and upholds department and hospital policies while serving as a positive example for staff. Addresses issues as they arise and uses the code of mutual respect in handling them. Embrace a team environment and helps others to join and participate in this environment by example and encouragement. Must be able to set clear expectations and have strong leadership skills.

Communication/Working Relationships/Training

Cheerfully greets patients, family members and visitors and makes every effort to ensure that they are processed or directed to the appropriate area in a timely manner. Answers questions and gives information based on department and hospital guidelines. Notifies departments when there are delays or late appointments, and keeps patients informed of wait times. Completes all mandatory in-services in a timely manner and attends scheduled departmental meetings. Routinely exhibits courtesy and respect when dealing with others. Answers all incoming calls within three rings, and ensures that standard departmental protocols are used when placing calls to physicians, hospital departments and other facilities to facilitate patient's care. Communicates identified problems to appropriate supervisory personnel and participates in corrective actions. Anticipates needs of co-workers and department and responds appropriately. Keeps up with changing needs and requirement of job.

ORGANIZATIONAL RESPONSIBILITIES

Associate complies with the following organizational requirements:

Attends and participates in department meetings and is accountable for all information shared. Completes mandatory education, annual competencies and department specific education within established timeframes. Completes annual employee health requirements within established timeframes. Maintains license/certification, registration in good standing throughout fiscal year. Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department. Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self. Adheres to regulatory agency requirements, survey process and compliance. Complies with established organization and department policies. Available to work overtime in addition to working additional or other shifts and schedules when required.
Commitment to Beacon's six-point Operating System, referred to as The Beacon Way: Leverage innovation everywhere. Cultivate human talent. Embrace performance improvement. Build greatness through accountability. Use information to improve and advance. Communicate clearly and continuously. Education and Experience The knowledge, skills and abilities as indicated below are acquired through the successful completion of a high school diploma or equivalent is preferred. Must be a minimum of 17 years of age. A minimum of one year of previous clerical/computer experience is preferred. A medical terminology course must be successfully completed during the first year of employment. Additional college-level courses in the area of medical practices are desired. CHAA certification and/or CMA certification is highly preferred.

Knowledge & Skills

Requires basic office and keyboarding skills (with the ability to type a minimum of 40 wpm) and the ability to use designated reference materials and office equipment (i.e., computer, printer, fax machine, calculator, etc.). Requires effective telephone skills (for example, to accurately take and relay information about patient and physician orders). Demonstrates proficient computer skills (i.e., data entry, word processing and spreadsheets). Requires the ability to use multiple databases (such as Star Navigator, Cerner, Rev Spring, Indiana Medicaid Portal, R1 Insurance Verification Tool, WebForm Imprint, PHS, PCA, pager system and Insurance Rolodex). Requires a complete understanding of Point of Service Collections. Specifically, must understand why it is necessary and must be able to effectively communicate this to the Beacon patient community as needed. Requires basic knowledge of medical terminology, private insurance coverage (and managed care). Demonstrates the interpersonal skills necessary to interact effectively with patients from various backgrounds in a professional, enthusiastic, courteous, friendly, caring and sincere manner. Also demonstrates the ability to maintain effective working relationships with other departments, physicians and their office staff. Demonstrates the verbal communication skills needed to communicate in a clear and effective manner when conducting patient interviews, answering patients' questions and communicating with other departments and physician offices. Good listening skills are required. Sensitivity to individuals who do not speak English as their first language is expected. Requires the ability to strictly follow Beacon's policy on confidentiality. Also requires the ability to be aware of the need to lower one's voice in certain situations. Requires ability to utilize good judgment and maintain one's composure in stressful situations. Requires basic math skills needed to make change when taking Point of Service payments.

Working Conditions

Works in a patient care area with possible exposure to biohazards. Requires a flexible work schedule (including evenings, nights, weekends and holidays) that meets the needs of the department. Must be effective in a quality-focused, multi-priority environment that frequently deals with stressful situations and promptly completes accurate registrations.

Physical Demands

Requires the physical ability and stamina (i.e., to walk moderate distances, climb stairs, lift up to 25lbs, reach, bend, stoop, twist etc.) to perform the essential functions of the position.