Patient Access Representative

Patient Access Representative Reports to the Department's Designee. Follows established policies and procedures to admit and register patients for services in a professional and courteous manner. Is responsible for accurate and complete registration of all patients. Must maintain regulatory and functional knowledge of all information required which ensures timely and accurate reporting/billing. Collects applicable co-payments and deductibles and completes insurance verification and must be able to accurately decipher eligibility responses and relay that information back to the patient. 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.

Registers patients (in order to obtain demographic, physician and insurance information in accordance with established departmental policies and procedures) and collects applicable co-payments and deductibles by:

• Interviewing patients for pre-admission or upon presentation for admission in the registration or designated area.
• Promptly works alerts through the Teletracking system by creating an account for all direct admits, transfers, and add-on procedures.
• Obtaining identification, demographic, physician and insurance information from patients and accurately entering this information into the financial system.
• Audits each account for demographic errors by using Financial Clearance Workstation (FCW).
• Updating the system after validation of the new patient's financial information.
• Using the Pathways Healthcare Scheduling (PHS) or Cerner databases to locate/retrieve scheduled patients for admission/registration input into STAR.
• Generating PHS and SurgiNet reports to facilitate pre-registration.
• Explaining about the possible need to pre-certify with the patient's insurance carrier in order to ensure maximum coverage to the limits of the insured's insurance policy.
• Verifying and documenting insurance coverage via online eligibility systems, internet resources or via telephone.
• Requesting copies of the insurance card(s) and driver's license or other government picture ID to confirm insurance benefits and identification.
• Providing the Medicare letter for Medicare patients; also completing the Medicare Secondary Payor Questionnaire (MSP) and Advance Beneficiary Notice (ABN).
• Validating medical necessity via the MCA Compliance Checker where applicable.
• Completing the MSP (Medicare Secondary Payor) questionnaire by asking the patient the questions based on patient availability.
• Requesting payment either during the pre-registration process or when the patient presents for service in accordance with policies and procedures.
• After collecting applicable co-payments and deductibles, posting patient payments (including cash, checks and credit cards) on the patient's account and generating a system receipt to give to the patient.
• Maintaining a cash drawer in order to make the appropriate change for patients making payment at the time of service; also responsible for balancing and reconciling the cash drawer at the end of the shift.
• Referring the patient to the Financial Counselors or Eligibility Specialists if they are unable to secure satisfactory payment arrangements and have a self-pay balance of $500 or more. Also assisting in obtaining additional patient information, copies of insurance card(s) and church information.
• Obtaining all required signatures for the "consent to treat" and assignment of insurance benefits forms.

Coordinates the insurance eligibility and pre-certification/documentation (PA) processes for patients by:

• Verifying insurance coverage and network status by using online eligibility systems and websites to determine the patient's benefits under the insurance plan.
• Audit insurance eligibility by using the Relay Connect dashboard to verify insurance is eligible and correct.
• Verify network eligibility for potential transfers for Transfer Direct.
• Obtaining VOB information from the insurance company, such as: co-payment, co-insurance, deductible, the amount of the deductible that has been met year-to-date, family deductible, maximum out-of-pocket limit and rehabilitation benefits.
• Obtaining pre-certification information from the insurance company's pre-certification unit (i.e., whether pre-certification is required, if the ordering physician has completed it, etc.).
• When the ordering physician has not completed the pre-certification, calling the physician's office to initiate the pre-certification process and following up until it has been completed.
• When the ordering physician has completed the pre-certification, documenting the authorization and releasing the account.

Coordinates other patient services and performs clerical duties by:

• Preparing patient statistics (i.e., percentages) regarding completed demographic information as requested by the Department Designee.
• Processes utilization review emails and physician orders to complete change patient types in Star.
• Works mismatch report to ensure that all patient types match the level of care order.
• Printing itemized bills for the patient upon receipt of co-payments or coinsurance (if requested).
• Entering authorization number in the appropriate field for proper and timely claims filing.
• Calculating co-payments and coinsurance for services rendered per the insurance companies request.
• Processing and filing reservations, pre-testing forms and testing results in an efficient manner.
• Process faxes from nursing units, diagnostic departments, ClaimAid, and social services to update patient information, add insurance, and register add on patients.
• Answering the telephone and communicating information in an appropriate manner according to approved MHSB standards and departmental policies and procedures.

Notifies the appropriate area of the patient's arrival and ensures that the patient is escorted to the appropriate location by:

• Notifying the assigned Unit of the patient's arrival.
• Preparing the patient's chart, ID band and labels for the medical record.
• Arranging for an escort to assist the patient to the assigned outpatient area or to the patient's room (by wheelchair or by walking with the patient).

Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by:

• Providing world class service at all times.
• Assisting the department to meet or exceed its quality assurance goals.
• Greeting and providing information to patients and their families in a professional and friendly manner.
• Acting as a representative of Beacon Health System and striving to make a good first impression.
• Striving to accurately process an optimal number of registrations (or pre-registrations) during one's shift.
• Communicating with the Department Designee regarding any concerns or problems.
• Maintaining records, reports and files as required by departmental policies and procedures.
• Performing time of service collections effectively by achieving assigned collections goals and maintaining strong patient relations.
• Completing other job-related duties as assigned.

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.

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 hospital or medical office experience is preferred. A medical terminology course must be successfully completed during the first year of employment. Additional college-level courses in the medical practices area are desired. Associate degree preferred. CHAA 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 patients, physician orders and referrals).
• Demonstrates proficient computer skills (i.e., data entry, word processing and spreadsheets). Requires the ability to use multiple databases (such as Pathways Healthcare Scheduling, RelayHealth, Cerner and MCA Compliance Checker).
• Requires a complete understanding of time-of-service collections. Specifically, must understand why it is necessary and must be able to effectively communicate this to Beacon Health System's patient community as necessary.
• 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 patient's 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 the basic math skills needed to successfully balance a cash drawer.

Working Conditions

• Works in an office environment. Also, may work in patient care areas with possible exposure to biohazards.
• Requires a flexible work schedule (including evenings, nights and weekends) that meets the needs of the Department.
• Must be effective in a quality-focused, multi-priority environment that frequently deals with stressful situations and important deadlines and schedules.

Physical Demands

• Requires the physical ability and stamina (i.e., to walk moderate distances, climb stairs, lift up to 15 pounds, reach, bend, stoop, twist, etc.) to perform the essential functions of the position.