Patient Access Representative

Major Responsibilities:

• Responsible for performing all job duties in a way that conforms to our customer service philosophy and consistent with our "AIDET" standards
  • 1) Greet and Acknowledge all patients and family members in a welcoming and prompt manner.
  • 2) Introduce the patient to our services, what they can expect while under our care. Utilize appropriate etiquette in all communications.
  • 3) Provide the patient with information on the likely time spent in the service area (duration) including time in registration and time in clinical service.
  • 4) Explain the nature of our work, why we ask for demographic, socio-economic, and financial information. Explain how we safeguard their information and use it to provide better care for them.
  • 5) Hand-patients off to the next area with a clear "thank you."
• When creating new registrations for walk-in patients, responsible for identifying insurance coverage, the benefits available, patient out-of-pocket expenses, and collecting co-insurance and co-payments.
  • 1) Uses electronic systems to confirm coverage while patient is present and discussing the findings with the patient. Follow established department policies to resolve issues related to patient's eligibility for coverage or issues in in-network status for the patient using Advocate's network.
  • 2) When working uninsured patients, screen for urgent status cases and follow charity procedure. Refer as appropriate for additional financial counseling. Engage leaders to resolve questions on urgent versus non-urgent/elective care.
  • 3) When assisting walk-in patients, screen orders for compliance with policy. Work with physicians, Care Coordinators, and clinical department leaders to communicate and resolve issues related to order quality and acceptable standards.
  • 4) Collecting appropriate out of pocket expenses in accordance with policy.
• Responsible for security authorization and precertification of inpatient and outpatient services.
  • 1) Maintains knowledge of all stand-alone computer software programs to verify eligibility.
  • 2) Stays current of all Federal and State regulations regarding billing.
  • 3) Ensures completion of all established policies and procedures for identification and notification of the Primary Care Physician in the case of HMO coverage plans.
  • 4) Informs Financial counseling, physicians, Care Coordinators, and Utilization Management of out of network or noncovered service limitations of managed care/commercial insurance where benefits are at risk.
  • 5) Notify Financial Counseling, physicians, Care Coordinators, and Utilization Management on cases where patients are found to be uninsured, or where the only insurance is Third Party Liability or Workers Compensation.
  • 6) Identify at risk balances related to Medicare co-days, lifetime reserve days and other Medicare coverage limits and communicate to Financial Counseling, UM and physicians.
  • 7) Identify at risk balances related to Medicaid eligibility rules and communicate to Financial Counseling, UM and physicians.
  • 8) Initiates communication to patient when authorization is not obtained and explain the potential financial impact and the patient responsibility for unauthorized services.
  • 9) Accurately collects and analyzes clinical data in support of prior authorization, and precertification as required by payor guidelines.
  • 10) Acquires and maintains current knowledge of all insurance requirements as it relates to patient/hospital responsibility and hospital billing.
• Responsible for the pre-registration and registration accuracy.
  • 1) Ensure accurate entry of patient demographic, insurance information in the ADT system with special attention to carrier code assignment, complete benefit, eligibility record and authorization data.
  • 2) Pre-registers and registers patients using established procedures for computer entry for all ancillary and nursing units, keeping current with their specialized needs and preparing necessary documents/records when necessary.
  • 3) During the pre-registration or registration encounter, provide detailed education to the patient on the contents of documents and forms requiring patient signature.
  • 4) Manage incoming and outgoing calls in order to complete pre-registrations with patients.
  • 5) Generates, assembles, and processes all required documents for completion of each registration.
  • 6) Maintains knowledge of State & Federal regulations governing Medicare, Medicaid and Mental Health registrations.
• Participates in departmental team building activities and in-services and other miscellaneous duties as assigned by leader.
  • 1) Contributes to the quality initiatives and mission by participating in team projects.
  • 2) Attends all required departmental in-services to stay current of all job changes and responsibilities.
  • 3) Assist leader in special assignments as may be needed to fulfill the mission of the department and the organization.

Education/Experience Required:

• High School Diploma with 2 years of experience in either Patient Access or any of the following related experience; general physician office support or billing office, insurance office, hospitality, or call center (any industry) Intermediate math skills acquired through classroom work or through work experience.

Knowledge, Skills & Abilities Required:

• Typing 25 WPM Basic understanding of web-based systems, proficiency in data entry.

Physical Requirements and Working Conditions:

• Ability to prioritize and organize workload Sophisticated interviewing, communication and negotiation skills Independent decision making Ability to work hours that verify based on needs of the organization including evenings, weekends and holidays. Ability to work as a team member.
• Must be able to sit, stand, walk, lift, carry, squat, and bend frequently as well as twist, rotate, and kneel occasionally throughout the workday.
• Frequently lifts up to 10 lbs. and occasionally lifts between 20 lbs. or more. This occurs when moving equipment and supplies and when transporting patients and/or charts.
• Must be able to push/pull up to 50 lbs. with assistance.
• Must have functional speech and hearing.
• Must be able to use hands with fine motor skills for keyboard data entry.
• Exposed to a normal office environment.
• Operates all equipment necessary to perform the job.
• Must be able to work a flexible schedule to support the needs of the department.

Addendum: In addition to the Accountabilities and Job Activities outlined in Sects. I. A. – I. D. of the Position Description for Patient Access Registrar the following accountabilities and job activities are applicable for registrars staffed at offsite imaging centers: E. Performs additional activities that facilitate patient flow and transition from registration to the clinical testing area including: 1. Performs Computerized Provider Order Entry (CPOE) for exams accurately and completely to transcribe written physician orders. Seeks clarification from technician and physician if needed. 2. Performs light duty cleaning of changing areas as needed. 3. Prints patient’s results CDs when required and distributes finished exam results CD to patient while complying with application HIPAA considerations. 4. Escorts patients to changing areas as needed.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.