Patient Access Representative 3

The University of Miami UHealth – department of Patient Access has an exciting opportunity for a Patient Access Representative 3.

CORE JOB SUMMARY

The Patient Access Representative 3 (On-Site) oversees the registration and financial clearance activities that will facilitate reimbursement for services rendered by the department and serves as functional expert for department peers.

CORE JOB FUNCTIONS

• Obtains, confirms, and enters demographic, financial, and clinical information necessary for financial clearance of scheduled patient accounts.

• Contacts patients’ families or physicians’ offices to obtain missing insurance information.

• Verifies insurance and confirms insurance eligibility of patient coverage benefits, notifying patient and referring physician in the event of failed eligibility.

• Collaborates with scheduling departments to identify add-on patients.

• Obtains necessary authorizations, pre-certifications, and referrals.

• Notifies patients of liabilities prior to date of service and collects funds.

• Maintains appropriate records, files, and accurate documentation in the system of record.

• Recommends new approaches to management for enhancing performance and productivity.

• Adheres to University and unit-level policies and procedures and safeguards University assets.

Department Specific Functions:

• Serves as Lead resource and functional expert. 

• Ensures smooth patient flow. 

• Provides supervisory coverage in the absence of Supervisor. 

• Identifies and recommends new approaches to management for enhancing team performance and productivity. 

• Projects a welcoming professional demeanor. 

• Interacts and works effectively with patients of all ages, and the healthcare team to ensure a favorable first impression and positive patient experience. 

• Coordinates wide range of functions from prearrival to discharge utilizing multiple systems including but not limited to: EPIC MyChart, Grand Central ADT, Cadence, Prelude, Radiant, OP Time, Care Everywhere, Resolute, Nice inContact Communication, and Aria Oncology simultaneously and independently to service patients promptly in a fast paced, constantly changing environment. 

• Performs pre-service validation prior to patient’s appointment for in person or virtual visits. 

• Assists patients in navigating self-serve technology options including but not limited to MyChart and Self check-in kiosks, in person or remotely.

• Coordinates patient flow to ensure timely check-in and arrival to service area. 

• Obtains, confirms, and accurately enters and updates demographic, financial, and clinical HIPAA protected information. 

• Reviews real time eligibility insurance responses and/or master contract tool and updates coverages as needed. 

• Conducts critical communication with patients or legal guardian facilitating the understanding of and obtaining signature on legal, ethical, and compliance related documents.

• Serves as gatekeeper, performs insurance verification, and obtains referrals and/or authorizations as needed. 

• Provides financial counseling services at check-in, explains benefits, creates estimates, and notifies patients of self-pay liabilities including co-pays, deductibles, co-insurances, global self-pay packages, and previous balances for both hospital technical and professional components and collects thereby reducing AR, Bad Debt, and collection costs by collecting patient’s financial responsibility upfront.

•   Promotes the use of effective methods of communication and collaborates with providers and clinical team schedulers in coordinating and scheduling complex follow up care onsite or remotely.

•   Handles high volume of incoming and outgoing calls promptly.

• Answers and triages incoming calls, listens to patient/customers’ needs, responds to questions, provides helpful solutions, directs calls, and documents messages using appropriate software in accordance with established protocol. 

• Collects and processes large amounts of currency and performs end of day cash-drawer reconciliation and timely bank deposits. 

• Assists department in meeting all established key performance indicator goals: Co-pay, Previous Balances, Estimate Collections, Patient Satisfaction, Accuracy Rates, and Processing Time. 

• Maintains a close working relationship and open communication with all members of the healthcare team to ensure a seamless check in, check out, clinic flow and positive experience for patients and caregivers. 

• Recognize, analyze, solve, and de-escalate issues that may arise during workday by applying sound judgement and critical thinking.

•   Ensures proper physical distancing is always maintained following established guidelines. 

• Works with healthcare team to resolve unique situations and troubleshoot issues. 

• Cross trained to carry out all Front-End Revenue Cycle and Clinical Support functions and able to float across all areas and assist as needed. 

• Knowledge of health care regulatory guidelines and compliance requirements including but not limited to: OSHA, HIPAA, JC, AHCA, EMTALA, and CMS. 

AREA SPECIFIC 

ER  

• Must possess a good understanding of the unique characteristics and operations of the Emergency Room to proficiently support. 

• Proficient knowledge of ASAP module. 

• Must be flexible and adjust to rotating schedules evenings, weekends, and holidays. 

• Able to perform ADT functions (as described under Admitting section) afterhours, weekends, and holidays. 

• Must adhere to PPE requirements as dictated by the specific situation. 

ADMITTING 

• Must possess a good understanding of the unique characteristics and operations of Admitting to proficiently support the area. 

• Proficient knowledge of ADT module. 

• On-call and rotating schedule for evenings, weekends, and holidays. 

• Explains and obtains patient acknowledgment for all required regulatory documents including but not limited to the HIPAA Facility Directory Form, and CMS MOON, HOON, and IMM notices.  

• Obtains information from patient to complete Patient Self Determination Checklist and collects and scans pertinent documents.  

• Responsible for obtaining, confirming, and documenting eligibility and benefits, and providing health plan admission notification.   

• Responsible for pre-admissions log to include benefits, specialty, and financial clearance.  

• Coordinates with bed control on bed availability.  

• Collaborates with Transfer Center on all incoming transfers to finalize transfer requests.  

• Responsible for processing admissions orders received via in-basket messaging. 

• Extensive collaboration with providers, nursing unit, and utilization review department in coordinating admissions.  

CTU 

• Must possess a good understanding of the unique characteristics and operations of CTU to proficiently support the area. 

HOSPITAL BASED CLINIC 

• Must possess a good understanding of the unique characteristics and operations of the hospital-based department/clinic/division to proficiently support the area. 

PRACTICE BASED CLINIC 

• Must possess a good understanding of the unique characteristics and operations of the practice-based department/clinic/division to proficiently support the area. 

REMOTE BASED 

• Must possess a good understanding of the unique characteristics and operations of remote based call center operations to proficiently support all Front-End Revenue Cycle and Clinical Support remote functions. 

This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.

CORE QUALIFICATIONS

• High School Diploma or equivalent

• Minimum 3 years of relevant experience required

Knowledge, Skills and Abilities:

• Learning Agility: Ability to learn new procedures, technologies, and protocols, and adapt to changing priorities and work demands.

• Teamwork: Ability to work collaboratively with others and contribute to a team environment.

• Technical Proficiency: Skilled in using office software, technology, and relevant computer applications.

• Communication: Strong and clear written and verbal communication skills for interacting with colleagues and stakeholders.

Any relevant education, certifications and/or work experience may be considered.