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Patient Access Representative
4 months ago
Job Description
OverviewAt Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence-based practice to improve outcomes – to every patient, every time.
We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island’s Top Workplace.
St. Charles Hospital is a proud member of Catholic Health and has served the residents of the Three Village area for more than 110 years. St. Charles is renowned for its outstanding customer service and scored as one of the top hospitals on Long Island in the delivery of high quality care. This non-profit hospital features three centers of excellence: Maternal/Child services, Orthopedics and Rehabilitation. St. Charles also offers services in general surgery, colon/rectal surgery, bariatric surgery, neurosurgery, ENT, pediatrics, diagnostic imaging, emergency medicine, epilepsy, stroke care, Female Pelvic Floor Disorders Center, and a nationally accredited Sleep Disorders Center.
Job Details
Patient Access Representative will communicate hospital policies, procedures, and regulations to patients and obtain correlating consent forms.
Responsibilities:
Registration
Interview patients prior to, or as they arrive to verify and/or obtain demographic, insurance, employer and general encounter information. Confirm with the patient/responsible party the need for pre-certification and/or authorization for tests. Notify patient or patient representative of the expected out-of-pocket expenses (deductible, copayment, non-covered service Confirm that initial and all subsequent authorizations are obtained in a timely manner and maintained on designated patients. Utilize analytical, problem solving skills to determine the best course of action toresolve any admission problems. Keep Supervisor informed of any potential services that may be at financial risk.
Propose innovative ideas and solutions to enhance operational efficiencies. Maintain knowledge of The Joint Commission and state/federal regulations, laws and guidelines that impact Patient Access Services. Validate appropriate demographic, clinical and financial information has been collected to ensure excellent patient experience. Complying with Medical Necessity protocols and proper use of Compliance Checker and National Coverage Decisions. Maintain knowledge of payer regulations and hospital charging and collection policies. Stay abreast of changes in Medicare, Medicaid and third-party payer reimbursement requirements. Responsible for other duties as assigned.Scheduling & Pre-Registration
Collects necessary data in order to create a complete and accurate preregistration for scheduled appointments. Verifies insurance activity via insurance eligibility systems in order to confirm active status. Follows department specific scheduling guidelines and insurance parameters when scheduling appointments. Appropriately communicates to patients any relevant insurance information.Insurance Verification (when required)
Confirm that a patient’s health insurance(s) is active and covers the patient’s procedure; may be completed multiple times before, during, and after a patient’s visit/stay. Document a patient’s health insurance benefits and coverage for their visit including effective date of the policy, product line, coverage limitations / requirements, and patient liabilities for the type of service(s) provided. Check benefits to determine deductible, coinsurance, and copayment amounts due. Use procedure estimate process/program to notify the patient of the amount due. Make patients aware of financial obligations and appropriately refer them to financial counseling when necessary. Verify a patient’s network status (in or out-of-network) with their plan and communicate to the patient in advance if an out-of-network status applies. Ensure payer requirements including the following are met: Verify and document insurance eligibility; confirm and document benefits Review and analyze patient visit information to determine whether authorization is needed and understand payer specific criteria to appropriately secure authorization and clear the account prior to service where possible.Requirements:
Education:
High School Diploma or GED required.
Skills , Knowledge or Abilities :
Comprehensive understanding of insurance, pre-certification, requirements, and medical terminology. Work requires the ability to access online insurance eligibility and pre-certification systems. Must be customer focused with strong interpersonal skills, courtesy and tact with patient, family members, physicians and staff members. Work requires a high level of problem solving skills Work requires the ability to interpret and execute policies and procedures. Work requires the ability to ensure the confidentiality and rights of patients and the confidentiality of hospital and departmental documents. Must be able to demonstrate a working knowledge of personal computers and other standard office equipment Must demonstrate a positive demeanor, good verbal and written communication skills, and be professional in appearance and approach. Must be able to handle potentially stressful situations and multiple tasks simultaneously. Must be able to successfully complete additional job related training when offered.Salary Range
USD - USD /Hr.
This range serves as a good faith estimate and actual pay will encompass a number of factors, including a candidate’s qualifications, skills, competencies and experience. The salary range or rate listed does not include any bonuses/incentive, differential pay or other forms of compensation that may be applicable to this job and it does not include the value of benefits.
At Catholic Health, we believe in a people-first approach. In addition to the estimated base pay provided, Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth.
