Patient Access Representative 3

• Leadership -Develops schedules to ensure adequate staffing on all shifts to facilitate effective and efficient Patient Access Services operations.
• Provides day to day work assignments, oversight and leadership to staff and works with the department management to set standards, develops and executes improvement plans.
• Assists with providing hands on training to new employees and working with existing employees who require retraining or need to learn a new aspect of their job.
• Alerts management of any backlogs in processing and provide suggestions for resolution.
• Coaches and mentors less experienced team members on all aspects of the revenue cycle, payer issues, policy issues, or anything that impacts their role.
• Reviews and resolves accounts that are complex and require a higher degree of expertise and critical thinking.
• Performs daily accuracy reports and quality assurance reviews of patient accounts as directed.
• Responsible for obtaining complete and accurate demographic, financial, and clinical information to help ensure maximum reinbursement for the hospital.
• Provides input and assistance to PAS management in developing and implementing policies and procedures.
• Registration - Performs financial clearance process by interviewing patients and collecting and recording all necessary information for pre-registration and registration of patients.
• Ensures that proper insurance payer plan choice and billing address are assigned in the automated patient accounting system.
• Verifies relevant group/ID numbers.
• Completes the registration process according to established policies and procedures.
• Ensures patient receives necessary disclosures, privacy information and signs the relevant documentation.
• Financial Clearance - Contacts payers to verify insurance eligibility.
• Completes automated insurance eligibility verification, when applicable and appropriately documents information in the patient accounting system.
• Determines the patient’s insurance type and educates patients regarding coverage and/or coverage issues.
• Informs families with inadequate insurance coverage regarding financial assistance through government and financial assistance programs.
• Performs initial financial screening and refers accounts for financial counseling and/or appropriate eligibility assessments.
• Ensures all referrals and treatment authorizations for all patient types have been obtained according to the outlined requirements.
• If not obtained, contact payers for approvals.
• Completes initial medical necessity checks, refers to designated area if medical necessity fails or if referrals /authorizations are denied.
• Collect co-payments, co-insurance, and deductibles according to pre-service/ point of service collections policies and procedures.
• Communication & Miscellaneous - Advises next-level leader of possible postponement or deferrals of any elective/non-emergent admission which has not been approved prior to service date.
• Maintains accurate files for pre-processing information as required.
• Assists with cross training function in areas within Patient Access services.
• Performs related responsibilities as required or directed.

EDUCATION: -

• Associates degree in business, healthcare or related field preferred, or commensurate experience of two (2) years in additional to minimum experience requirement

EXPERIENCE:

• 3-4 years health care or related experience required