This position is responsible to conduct a comprehensive registration with minimal assistance, in person or by phone. This includes identifying all potential payer sources, including federal, state and county assistance programs, which will ensure reimbursement for the services being rendered. Whenever possible, such screening will be done prior to admission. The incumbent is responsible to ensure this process is expeditious, non-imposing and insurance authorizations completed meeting payer requirements. This position is accountable for timely coordination and accurate relay of information pertaining to patient admissions and insurance authorizations and potential denials by payers.
This position takes initiative to overcome roadblocks and prioritize workload, ensuring that accounts are financially secured and analyzed to ensure that all barriers / avoidable days are identified and communicated to the appropriate personnel. The incumbent must use diplomacy in communicating effectively to patients, guardians, family members, physicians and co-workers. In addition, the incumbent is responsible to coordinate with the interdisciplinary teams to ensure a seamless admission and discharge process. The incumbent will maintain all necessary activity logs / required documentation with regard to insurance authorizations and potential or actual denials as directed by their immediate supervisor.
The responsibilities of the Patient Access Representative Senior includes but is not limited to the following:
• Performing technical aspects of work (80%) within team area of responsibility while prioritizing time (20%) to allow for:
§ Developing team members through group, as well as one-on-one, training and in-services.
§ Facilitating, implementing, monitoring, and appropriately reacting to quality assurance mechanisms.
§ Monitoring and developing workflows to improve Patient Experience.
§ Developing and revising procedures relevant to the assigned area, coordinated with other Patient Access teams.
§ Conducting data integrity audits and shares results with representatives and department leadership; works with representatives to improve performance as necessary.
§ Working with Patient Access Leadership to resolve operational issues.
§ Co-development, communication, and tracking of progress towards meaningful goals.
§ Ensuring patient financial liabilities are being properly estimated and provided to the patient. Produces education for Patient Access personnel to improve on financial collection techniques.
§ Participates in and/or assists with quality management processes.
§ Working with Patient Access Leadership on department projects.
• Acts as a resource for day-to-day operations questions.
• Serves as customer service resource for walk-in patients in hospital lobby/patient registration area.
• Maintains a thorough understanding of federal and state regulations, payer requirements, and third party financial assistance programs.
• Holds sufficient understanding of insurance protocols for referrals, co-payments, deductibles, allowances, etc., and analyzes information received to determine patients’ out-of-pocket liabilities.
• Trains and performs on-boarding for newly hired employees.
• Performs audits to ensure registration practices are compliant with government payer regulations through registration audits, authorization information is obtained for services from payers (collect referrals and authorization numbers and document user comment fields as appropriate).
• Ensures Patient Access personnel explain and obtain each patient’s signature on consent forms as needed. Makes copies of insurance cards and patient identification.
• Collects and confirms complete patient demographic information—including employer, financial information, emergency contact, insurance, subscriber ID, etc.—and case-specific information, such as referring physician/primary care provider and diagnosis/chief complaint.
• Collects out-of-pocket liabilities from patients upfront and applies, adjusts, and reconciles daily point of-service cash reports.
• Prepares and reconciles cash deposits as necessary.
The position is required to meet goals and productivity standards set by management. This includes performing quality assurance controls to ensure the final product produces a clean claim and meeting collection goals. This position also performs other duties as assigned by their direct and indirect supervisor / manager / director.
This position is responsible to show through their actions the highest level of professionalism in accordance with the Living our Values. This includes adhering to dress code requirements and taking initiative to make a genuine difference by optimizing our patient’s healthcare experience.
This position does not provide patient care.