Emergency Department Outpatient Patient Access Representative

Job Category:

Revenue Cycle

Work Shift/Schedule:

Varies

Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role:

Job Summary

Under the supervision of The Patient Access Supervisor, this position is responsible for ensuring the delivery of outstanding customer service while greeting patient, registering patient and verifying or obtaining complete and accurate patient demographic information, identifying patient benefits eligibility, verification of pre-certification obtained from insurance companies and/or physicians offices, identifying insurance and/or patient responsibility, collecting identified co-pay/deductible, co-insurance, and/or providing financial counseling when appropriate, and completing the entire registration process.    
 

Minimum Job Qualifications

• Licensure or other certifications:

• Educational Requirements: High School Diploma or GED

• Minimum Experience: Proficient in the use of office equipment (computer, fax, telephone, scanning copier). Must be mobile and push patient in wheelchair, if necessary between any location within hospital campus.

• Other:

Preferred Job Qualifications

• Preferred Licensure or other certifications: Bilingual preferred

• Preferred Educational Requirements: Associate or Bachelors Degree in Business, Financial/HealthCare related field.

• Preferred Experience: Medical terminology, data entry and computer experience, admitting, business office, collection, physician office experience and working with public preferred.

• Other:

Job Specific and Unique Knowledge, Skills and Abilities

• Ability to work independently, emotionally mature and able to function effectively under stress while continuing to demonstrate positive attitude with patients at all times

• Excellent problem solving and analytical skills

• Working knowledge of Protected Health Information

• Ability to be flexible and manage change. Excellent written and oral communication skills required.

• Must be proficient with use of all Patient Access Systems, Software Application and Processes

• Must be able to demonstrate knowledge of billing requirements and proper documentation of

• Must possess detailed understanding and knowledge of insurance guidelines and protocols, the components of full verification, and payor information / requirements

Essential Tasks and Responsibilities

• Responsible for capturing and documenting all pertinent patient demographic, subscriber, and insurance information ie; patient Policy and ID numbers, subscriber, guarantor, payor address, phone number, and contact information. Documentation must include, effective date, copay, deductible, out of pocket, co-insurance, and stop loss amounts, percentage of coverage and any other pertinent information concerning the specific visit into the EHR system. 

• Obtains complete and accurate insurance information; completes insurance verification by contacting patients, physician offices and insurance/payer regarding the visit; verifies patient’s insurance eligibility and benefits with the information obtained.

• Reviews work and assures accuracy in all aspects of the position; particularly patient type, visit type, code identification, insurance information, and demographic information to minimize error rate and time delays in other areas.

• Responsible for assessing and collecting financial liabilities prior to service when applicable; educates patients on billing process for the facility; refers patients for financial counseling if applicable; documents payment information in system as appropriate.

• Scans appropriate data into Document Management System (including, but not limited to; insurance cards, drivers license, physician orders, consent forms, and any other registration related documents pertinent to the patient's medical record ).

• Identify patient's history in all Patient Access Systems to avoid duplication of medical records.

• Responsible for confirming and updating EHR system with pre-certification information for all scheduled and non-scheduled outpatient accounts as applicable.

• Performs medical necessity checks on all appointments in which it is applicable; completes ABN form upon any failure to meet medical necessity.

• Obtains and accurately completes MSP forms when applicable.

• Demonstrates ability to complete and explain all registration related consents and other documents as needed to the patient.

• Responsible for preparing patient packets for next day's scheduled procedures (varies per area).

• Works according to standard operating procedure during EHR or other system downtimes.

• Responsible for working with physician offices and other departments to ensure patient satisfaction is met.

• Understands and utilizes all systems appropriately as related to the registration process.

• Expected to meet all goals set by department management to include, but not limited to; productivity, accuracy, collections, and customer satisfaction.

• Performs any and all related job duties as assigned; may have additional department specific duties assigned as deemed necessary by management.

• Must maintain open and positive professional communication  (oral and written) as well as great attitude at all times.

• PRN for Registration and ED Registration are responsible for accurately performing any and all functions listed above.

Physical Demands

• Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time

• Weight Carried: Up to 20 lbs, Occasionally 0-30% of time

• Vision: Heavy, Occasionally 0-30% of time

• Kneeling/Stooping/Bending: Occasionally 0-30%

• Standing/Walking: Frequently 31-65%

• Pushing/Pulling: Occasionally 0-30%

• Intensity of Work: Frequently 31-65%

• Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals. 

NGHS: Opportunities start here.

Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.