Patient Access Representative I

Category:

Nursing Unlicensed

City:

Camden

State:

Tennessee

Shift:

0 - Day (United States of America)

Job Description Summary:

Responsible for assisting medical provider with direct patient care, performs clerical/ environmental duties and organizational compliance task. This position is responsible for completing the financial clearance process within Patient Access Services (PAS) and creating the first impression of WTH's services to patients and families and other external customers. Provides medical care and information to patients so that they may fully utilize and benefit from clinic services. Must be able to articulate information in a manner that patients, guarantors, and family members understand so they know what to expect and have an understanding of their financial responsibilities. This position assumes responsibility for collecting and documenting information on behalf of the patient. Responsible for obtaining, coordinating, and directing information from patients, physician offices, hospital departments, and clinics in order to schedule patient appointments. May be responsible for completing the pre-registration, registration, insurance verification, benefits verification, certification, referral management, patient liability collections, and medical necessity check -- as well as interviewing patients and guarantors to obtain information to screen for financial counseling, verifying eligibility and corresponding benefit levels, coordinating referrals, and obtaining treatment authorizations. Employee is subject to call back and overtime as required.

ESSENTIAL JOB FUNCTIONS:

• Fulfills patient care duties to include checking schedules and organizing patient flow; accompanying patients to exam/ procedure room; assisting patients as needed with walking, transfers, dressing, collecting specimens, preparing exam room/ setting up instruments etc.; collecting patient history; performing screenings/ lab test per Medical Provider's orders; assisting Medical Provider/ other License nursing staff with various procedures; charting; relaying instructions to patients/ family; answering telephone calls and providing pertinent information.
• Fulfills clerical duties to include sending and receiving patient medical records; completing patient referrals for diagnostic test or specialist services; completing other forms and requisitions as needed; scheduling appointment / verifying insurance coverage; entering patient demographics; managing charts to ensure information is completed and filed appropriately.
• Fulfills environmental duties to include cleaning exam / procedure room/ instruments and equipment between patient visits to maintain infection control; sterilize any equipment or instruments according to scheduled maintenance program; keeping appropriate records; ordering, sorting, storing supplies; restocking exam/ procedure rooms;
• Fulfills organizational duties to include respecting and promoting patient rights; responding appropriately to emergency codes; following all Clinic Policies and Procedures and System wide policies
• Contributes to a positive work environment and the overall team effort of the clinic.
• Process - Maintains the best practice routine per department guidelines.
• Daily work queues are maintained at acceptable levels according to department policies.
• Correspondence worked daily to current.
• Registration - Performs financial clearance process by interviewing patients, 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.
• Responsible for obtaining complete and accurate demographic, financial, and clinical information to help ensure maximum reimbursement for the hospital.
• Pre-Service / Point of Service Collection - Interprets third party payer policies to establish patient financial liabilities and work with patients so they understand their patient financial responsibilities.
• Collect co-payments, co-insurance, and deductibles according to pre-service/ point of service collections policies and procedures.
• Investigates, resolves, and documents patient problems in a timely and efficient manner.
• Investigates, resolves, and documents patient problems and contact medical staff, nursing staff, ancillary departments, and administration as necessary.
• Referrals-assist with referrals internally.
• Must submit for prior authorization if needed, schedule appointment within clinic.
• Follow through with referral process until patient has been contacted with appointment.

EDUCATION:

• Must have High School diploma,
• Completed WTMG/JSCC hosted MOA certification program

LICENSURE, REGISTRATION, CERTIFICATION:

• Certified MOA program completed through WTMG/JSCC hosted program - ONLY.
• Attain CPR certification during the introductory period and maintain certification during employment.

EXPERIENCE:

• Must have worked in WTMG PAR position
• Must have completed WTMG/JSCC hosted MOA program

KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge of health care field and/ or medical specialty.
• Knowledge of specific assisting task related to health care or the particular medical specialty.
• Knowledge of information that must be conveyed to patients/ families.
• Knowledge of healthcare management, registration, billing, and collection processes for government, grant, and non-government funding sources.
• Strong attention to detail and ability to obtain and record information accurately in the patient accounting system.
• Ability to learn and apply various rules, regulations, policies and procedures, criteria and eligibility thresholds set forth by WTH external government/regulatory agencies, and payer contracts.
• Comfort with data entry within Revenue Cycle software, patient management systems, and Windows based applications preferred.
• Knowledge of word processing and spreadsheet applications.
• Strong interpersonal skills and the ability to work through a variety of issues in a diplomatic fashion required.

INTERPERSONAL REQUIREMENTS:

• Require skills of tact and diplomacy; ability to project a pleasant and professional image; ability to demonstrate compassion and caring in dealing with patients and peers.
• Contributes to a positive work environment and the overall team effort of the department.

NONDISCRIMINATION NOTICE STATEMENT

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, disability, religion, national origin, gender, gender identity, gender expression, marital status, sexual orientation, age, protected veteran status, or any other characteristic protected by law.