Patient Account Specialist 1

Where compassion meets innovation and technology and our employees are family.

This position reports to the department manager. This position is responsible for the creation of the patient account in the EMR patient accounting system in support of patient care departments and in support of the revenue, billing, and reporting cycle to also secure reimbursement. This includes but is not limited to functions under the categories of patient accounting, referral order record management, patient scheduling, pre-registration/registration or pre-admission, admission, verification of patients’ benefits, gather & document insurance benefit details, authorization procurement as required by payer policy, creating estimate of cost, documentation of the authorization and/or referral order record, obtaining consent signatures, granting MyChart or MyChart non-patient proxy account access, documentation of actions taken and of patient financial discharge task. This role serves as a key promoter of service excellence which, along with the team, strives to meet and exceed the needs of their customers.

Essential Duties and Responsibilities:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily to achieve clean claim processing. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or hospital administration as required.

• Always maintains utmost level of confidentiality.

• Adheres to hospital policies and procedures.

• Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.

• Adheres and comply with customer service standards and dress code as set forth by the hospital and the department.

• May be required to work rotating shifts.

• This position is an essential role and may be part of the disaster plan A or B team during disaster events.

• Occasional travel may be required.

Customer Service Duties – utilizing the Driscoll Way to Service Excellence

• Answers the department telephone immediately or within three rings utilizing courtesy and patience

• Greet patients and their families with courtesy and concern for their needs using the Driscoll Way to Service Excellence

• Listens to customer needs and takes appropriate action as indicated.

• Work cooperatively with all levels of staffing and care settings to accomplish desired care outcomes.

Patient Accounting Duties

• The Patient Account Specialist will process patient accounts according to established workflow designs.

Work cooperatively with DAC [Driscoll Access Center] staff to process expected ED admissions, direct admissions, and transfers and create CCT or HBRT encounters as indicated.

Process provider orders for care; search for referral order first, if not found, create referral record.

Accurately create patient record and or encounter in patient accounting systems utilizing the appropriate patient search criteria, using the established naming convention, and interview method while being open and transparent with customers. Gather patient demographic and financial information in a kind and courteous manner.

Verify patient’s insurance benefit and document findings, this process should be completed in the appropriate timeframe for the service being provided; refer to Emergency Medical Treatment and Labor Act -EMTALA guidelines for ED arrivals/services

Follow payer requirements for payer authorization procurement workflows and

admission notification.

Schedule patients for necessary procedures as indicated, using the appropriate scheduling system and obtain authorization for all planned services as indicted by insurance carrier.

Request and follow cases for required questionnaires & documents such as H&P, PCP Referral, CPS Consents.

Complete an emergency visit arrival event in a timely manner.

Reschedule patients upon patient request and notify the patient’s physician.

Add notes to each encounter in patient account notes as indicated, brief but important details only

Manage an appointment waiting list and canceled list as indicated to ensure services are provided promptly

Refer cases for financial screening as necessary.

Add a clear copy of picture identification and insurance cards, front and back to the patients Electronic Medical Record - EMR

Explain all business forms and obtain signatures.

Issue Patient Rights and Responsibilities and the hospital’s Notice of Privacy Practice as indicated.

Issue patient identification card or wristband identification as appropriate. Ensure the patient/family is escort to the appropriate service area.

Contact the Patient Intake Nurse for all direct admissions as indicated.

Manage admissions to the various service areas as directed.

Follow discharge workflows as directed by service area.

Manage visitor volume at Welcome desks or in the admitting office daily as indicated.

Quality Assurance Duties

• Review & manage work queues to identify potential duplicate referrals numbers, HARs, or medical record numbers.

• Review & manage patient accounting work queues by area to address missing reg items per encounter.

• Review & manage patient demographic and financial data for accuracy.

Patient Financial Discharge Duties

• Review documented notes for payment requirements; explain insurance benefits as quoted to us by their insurance carrier, provide an estimate of charges and explain billing workflow.

• Refer cases for financial screening as indicated.

• Prepare hospital receipt for payment received.

• Validates name, address, and phone number, to ensure you are in the correct record & update as needed.

• Ensures all paperwork is complete and all insurance cards and identification cards are copied for business record.

• Document all actions taken at discharge in patient accounting system.

Cashiering Duties

• The department’s petty cash will always be in balance.

• Payments received will always be receipted and reconciled, daily per shift.

• The department Standard Operating Procedure for cash handling will be followed.

EDUCATION AND/OR EXPERIENCE:

High school diploma or general education degree (GED) required; and one-year related experience and/or training preferred.