Patient Access Rep; TRH

This position reports to the Department's Designee and follows established policies and procedures to admit and register patients for services in a professional and courteous manner. The individual is responsible for accurate and complete registration of all patients, maintains regulatory knowledge, and handles all billing and collection aspects.

• Mission:
  We deliver outstanding care, inspire health, and connect with heart.
• Values:
  Trust. Respect. Integrity. Compassion.
• Service Goals:
  Personally connect. Keep everyone informed. Be on their team.

• Interview patients for pre‑admission or upon presentation for admission in the registration or designated area.
• Promptly work alerts through the Teletracking system by creating an account for all direct admits, transfers, and add‑on procedures.
• Obtain identification, demographic, physician and insurance information from patients and accurately enter this information into the financial system.
• Audit each account for demographic errors by using Financial Clearance Workstation (FCW).
• Update the system after validation of the new patient's financial information.
• Use the Pathways Healthcare Scheduling (PHS) or Cerner databases to locate/retrieve scheduled patients for admission/registration input into STAR.
• Generate PHS and Surgi Net reports to facilitate pre‑registration.
• Explain the possible need to pre‑certify with the patient's insurance carrier to ensure maximum coverage to the limits of the insured's policy.
• Verify and document insurance coverage via online eligibility systems, internet resources or by telephone.
• Request copies of the insurance card(s) and driver's license or other government picture  confirm benefits and identification.
• Provide the Medicare letter for Medicare patients; also complete the Medicare Secondary Payor Questionnaire (MSP) and Advance Beneficiary Notice (ABN).
• Validate medical necessity via the MCA Compliance Checker where applicable.
• Complete the MSP questionnaire by asking the patient the questions based on availability.
• Request payment either during the pre‑registration process or when the patient presents for service in accordance with policies and procedures.
• Post patient payments (cash, checks, credit cards) on the patient's account and generate a system receipt to give to the patient.
• Maintain a cash drawer to make change for patients; balance and reconcile drawer at shift end.
• Refer patient to the Financial Counselors or Eligibility Specialists if unable to secure payment arrangements and the self‑pay balance is $500 or more.
• Obtain all required signatures for the "consent to treat" and assignment of insurance benefits forms.

• Verify insurance coverage and network status using online eligibility systems to determine benefits.
• Audit insurance eligibility using the Relay Connect dashboard to verify eligibility and correctness.
• Verify network eligibility for potential transfers for Transfer Direct.
• Obtain VOB information from the insurance company (co‑pay, co‑insurance, deductible, etc.).
• Obtain pre‑certification info from the insurance pre‑certification unit.
• When pre‑certification is not completed, call the physician's office to initiate and follow up until completion.
• When pre‑certification is completed, document authorization and release the account.

• Prepare patient statistics (percentages) on completed demographics for Department Designee.
• Process utilization review emails and physician orders to change patient types in STAR.
• Create mismatch report to ensure patient types match the level of care order.
• Print itemized bills for co‑payments or coinsurance if requested.
• Enter authorization number for proper claims filing.
• Calculate co‑payments and coinsurance per insurance requirement.
• Process and file reservations, pre‑testing forms and testing results efficiently.
• Process faxes from nursing units, diagnostic departments, Claim Aid, and social services to update patient info, add insurance, register add‑on patients.
• Answer telephone and communicate information per MHSB standards and departmental policies.