Patient Access Representative

Overview

Reports to the Department's Designee. Follows established policies and procedures to admit and register patients for services in a professional and courteous manner. Is responsible for accurate and complete registration of all patients. Must maintain regulatory and functional knowledge of all information required which ensures timely and accurate reporting/billing. Collects applicable co-payments and deductibles and completes insurance verification and must be able to accurately decipher eligibility responses and relay that information back to the patient.

Obtains all required signatures on paperwork and performs clerical duties as necessary.

• 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.

• Registers patients (in order to obtain demographic, physician and insurance information in accordance with established departmental policies and procedures) and collects applicable co-payments and deductibles.
• Interviewing patients for pre-admission or upon presentation for admission in the registration or designated area.
• Prompts through the Teletracking system by creating an account for all direct admits, transfers, and add-on procedures.
• Obtains identification, demographic, physician and insurance information from patients and accurately enters this information into the financial system.
• Audits each account for demographic errors using Financial Clearance Workstation (FCW).
• Updates the system after validation of the new patient's financial information.
• Uses the Pathways Healthcare Scheduling (PHS) or Cerner databases to locate/retrieve scheduled patients for admission/registration input into STAR.
• Generates PHS and Surgi Net reports to facilitate pre-registration.
• Explains the possible need to pre-certify with the patient's insurance carrier to ensure maximum coverage to the limits of the insured's policy.
• Verifies and documents insurance coverage via online eligibility systems, internet resources or via telephone.
• Requests copies of the insurance card(s) and driver's license or other government picture  confirm insurance benefits and identification.
• Provides the Medicare letter for Medicare patients; completes the Medicare Secondary Payor Questionnaire (MSP) and Advance Beneficiary Notice (ABN).
• Validates medical necessity via the MCA Compliance Checker where applicable.
• Completes the MSP questionnaire by asking the patient the questions based on patient availability.
• Requests payment either during the pre-registration process or when the patient presents for service in accordance with policies and procedures.
• After collecting applicable co-payments and deductibles, posts patient payments (including cash, checks and credit cards) on the patient's account and generates a system receipt to give to the patient.
• Maintains a cash drawer and balances/reconciles it at the end of the shift; responsible for making the appropriate change for patients at time of service.
• Refers the patient to Financial Counselors or Eligibility Specialists if unable to secure satisfactory payment arrangements and has a self-pay balance of $500 or more; assists in obtaining additional patient information and copies of insurance card(s) and church information.
• Obtains all required signatures for the "consent to treat" and assignment of insurance benefits forms.

• Verifies insurance coverage and network status using online eligibility systems and websites to determine benefits.
• Audits insurance eligibility using the Relay Connect dashboard to verify eligibility and correctness.
• Verifies network eligibility for potential transfers for Transfer Direct.
• Obtains VOB information from the insurance company (co-payment, co-insurance, deductible, year-to-date deductible, family deductible, maximum out-of-pocket, rehabilitation benefits).
• Obtains pre-certification information from the insurance company's pre-certification unit and initiates or follows up on pre-certification as needed.
• When the ordering physician has completed pre-certification, documents the authorization and releases the account.

• Prepares patient statistics regarding completed demographic information as requested by the Department Designee.
• Processes utilization review emails and physician orders to update patient types in Star.
• Works mismatch reports to ensure patient types match the level of care order.
• Prints itemized bills upon receipt of co-payments or coinsurance (if requested).
• Enters authorization numbers for proper and timely claims filing.
• Calculates co-payments and coinsurance for services rendered per insurer requirements.
• Processes and files reservations, pre-testing forms and testing results efficiently.
• Processes faxes from nursing units, diagnostic departments, Claim Aid, and social services to update…