Patient Access Services Representative TMCOne Wilmot

SUMMARY: Assists medical care givers with patient management, tracking and monitoring requirements. Answers phones, pre-screens using appropriate triage skills, within allowable parameters calls in prescription re-fills, calls patients with test results and schedules patients for next appointments. Perform extensive centralized scheduling, insurance verification, referral, billing and payment posting responsibilities.

ESSENTIAL FUNCTIONS:

• Exhibits excellence in customer service through appropriate attitude and interaction with all patients, visitors and staff; adheres to and supports team members in exhibiting TMCH values of integrity, community, compassion, and dedication.
• Collects deposits or deductibles and advises patient or guarantor of insurance benefits and anticipated cost estimates; ensures that cash handling follows corporate policies.
• Ensures completion of financial documentation in accordance with TMCHs credit and collection policies.
• Explains all necessary compliance forms and obtains patient signature as required for regulatory agencies.
• Performs medical necessity screening and ensures compliance with system requirements.
• Interacts with physicians and/or physicians office staff to secure diagnosis, procedure details or authorizations and information for denials as needed.
• Uses medical terminology and scheduling knowledge to select correct procedure when scheduling and coordinates information with other departments as needed.
• Demonstrates knowledge of resources, staffing, instrumentation, and equipment specific to procedures to avoid scheduling conflicts.
• Performs patient registration activities to ensure accurate financial and biographical data and documentation have been obtained and properly entered into hospital records.
• Completes insurance processing; including account creation, insurance verification, notification, and authorization functions, follow ups on denials and no response claims.
• Communicates with departments/physicians for special requests, emergent cases, overbooking and add-ons; informs management about issues/problems with tools/times.
• Handles incoming telephone calls and exercises judgment in scheduling caller for correct procedure in appropriate service area; receives telephone requests to schedule from patients, physicians, physician office staff, employers, and hospital personnel, if applicable.
• Explains procedure preparations to patients so they are properly prepared before arriving at the hospital or clinics as needed.
• Documents all notification, authorization and eligibility information in the registration systems, uses electronic verification tools and web-based resources.
• Analyzes patient accounts, determines non-collectable accounts, and recommends bad debt or charity write-offs when applicable; analyzes and processes contractual write-offs.
• Arranges payment methods or extensions of credit with patients or representatives; evaluates accounts and determines payment dates based on patients ability to pay and hospital policies; explains charges, services, and hospital policy regarding payment of bills.
• Arranges account collections and contacts carriers to follow-up on balances due.
• Maintains current working knowledge of payer regulations, contractual agreements, computer updates, and new collection tools including understanding of the Fair Debt Collection Practice Act.
• Provides information about external financial assistance, including recommending third parties.
• May serve as a Medical Assistant when holds a Medical Assistant Certification.
• Processes Accounts Payable transactions such as: checks and posts payments to accounts receivable and verifies account balances; prepares, reconciles, balances, and batches daily deposits and prepares receipts for deposits; verifies totals on reports and forms as required. Reviews accounts with unusual balances after posting payments and adjustments. Researches and transfers monies between logs, as needed.
• Adheres to TMCH organizational and department-specific safety, confidentiality, values policies and standards.
• Performs related duties as assigned.

MINIMUM QUALIFICATIONS: EDUCATION: High School diploma or General Education Degree (GED), completion of vocational medical office training desired, or an equivalent combination of relevant education and experience.

EXPERIENCE: Preferred one (1) year of medical office and/or hospital experience to include healthcare eligibility and benefit analysis or scheduling experience for diagnostic testing and/or surgery.

LICENSURE OR CERTIFICATION: Some positions may require certification as a Medical Assistant (CMA).

KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge of office management practices, including billing and scheduling within healthcare.
• Knowledge of basic computer familiarity and experience and the ability to operate basic office equipment.
• Knowledge of patient care protocols and practices.
• Knowledge of general patient care practice, methods and regulations.
• Skill in evaluating patients needs or following up with a care-giver and then providing follow up support to patients.
• Skill in scheduling appointments and referrals.
• Ability to read or listen and comprehend simple instructions, short correspondence, and memos.
• Ability to write simple correspondence; ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
• Ability to read and interpret documents such as safety rules, procedure manuals, and governmental regulations.
• Ability to effectively present information and respond to inquiries or complaints from patients and/or their representatives and the general public.
• Ability to interpret and explain insurance benefits and patient financial responsibility.
• Ability to provide excellent customer service via phone and walk-ins.
• Ability to apply common sense understanding to carry out simple/detailed written or oral instructions.
• Applicants must have basic computer familiarity and experience and the ability to operate basic office equipment.