Patient Access Associate Team Lead

SUMMARY

Independently coordinates and performs multiple complex functions within the Patient Access department. Utilizes considerable judgment in interpreting departmental policies to resolve routine to complex inquiries or patient account problems. Identifies opportunities for process improvements, offers and implements solutions. Mentoring and coaching team members to identify and complete lean process improvements. Participates and coordinates meetings as a representative of the department. Serves as the primary resource to team members and Level III Patient Access Associates for training, complex patient accounts, etc. Performs all duties in a manner that promotes a team concept and reflects the mission, behaviors, core values, and philosophy of CT Children's Medical Center.

ROLE RESPONSIBILITIES

Administrative:

As a first line representative of CT Children's, this person must have the ability to deal compassionately and professionally with patients and families.

Following department protocol provides expert receptionist, secretarial support or Health Unit Coordinator functions.

Performs and manages with limited supervision a variety of administrative support activities in support of the unit operations.

Responds with tact and discretion to the needs of patients and families.

Maintains privacy and confidentiality by abiding by HIPAA policies.

Independently creates staffing assignments, scheduling, and delegation of tasks or work assignments.

Independently provides training and quality assurance to new and current staff members.

Independently identifies trends in process opportunities and provides educational training to team members for improvement.

Performs Quality Assurance (QA) & Training: Audits Complete Registration data including documentation records regarding incomplete information at time of scheduling/registration/account follow-up, patient or guarantor interaction, efforts to collect co-payments, estimated self-pay balances, and referrals to Medicaid.

Ensures all outstanding issues are resolved in a timely manner.

Identifies trends and conducts follow-up training to reduce number and frequency of outstanding issues.

Provides weekly review for new employees; at minimum monthly review for current employees.

Tracks and ensures employees drawers are closed in a timely fashion, per standard process.

Creates/maintains spreadsheets and databases for trend reporting to management.

Acts a liaison with patient accounting department for denials and account problem resolution.

Registration:

Collects and enters accurate demographic, guarantor and financial data for Emergency Department, Inpatient and Outpatient cases and Physician Practice Office appointments.

Verifies all required insurance and billing information and uses the proper payer plan codes.

Generates all necessary forms for patient visit and obtains patient/parent/legal guardian signature for Assignment/ Authorization and consent.

Performs pre-registration for scheduled patients and registers patients adhering to standard department procedure.

Makes corrections and updates patient information in ADT systems as necessary.

Asks patients/families whether their visit was satisfactory and attempts to address any questions/issues prior to patient departure.

Attempts to collect the patient liability, co-payment on all accounts at the designated collection point.

Documents thorough, clear, explanatory notes regarding reasons for incomplete information at time of registration and documents insurance verification method along with response. Documents concise and understandable comments regarding patient or guarantor interaction, efforts to collect co-payments and referrals to Financial Counseling.

Follows-up on open items to resolve outstanding issues and complete the file.

Reviews and works assigned work queues for registration information to ensure that accounts are accurate at time of visit and or billing.

Creates feedback loop to front-end user in regards to correct and complete registration.

Scheduling:

Schedules routine and complex appointments either in person or via telephone.

Creates/inputs routine and complex department provider appointments.

May schedule/coordinate appointments with other areas of the hospital.

Builds and maintains scheduling templates.

Ensure all consent and privacy forms are signed.

Work directly with DCF to obtain appropriate signatures/legal guardian information.

Tracks/Reports Daily Fill Rate, with correlated barriers if metric not met.

Front Office (Check-In):

Direct representative to department managers, as a resource on process, concerns, etc.

Arrives patients for their appointment in the ADT system.

Verifies demographic and insurance information at time of arrival (including securing patient financial liability at time of service).

Enters routine to complex patient charges into billing system for physician or care provider visits, according to protocol.

Independently performs check out process including scheduling or rescheduling future appointments.

Answer telephone and triage calls for the department.

Ensure all consent and privacy forms are signed.

Work directly with DCF to obtain appropriate signatures/legal guardian information.

Other front office duties as required.

Financial Clearance:

Direct process expert and insurance company liaison.

Responsible to work through and escalate difficult and/or abnormal accounts, through account resolution with payers, managers, etc.

Responsible for various workqueues of scheduled and/or non-scheduled appointments.

Communicates with insurance companies to obtain benefits, referrals, and/or authorization requirements.

Communicates with Clinical/Office staff regarding patient eligibility, authorization status, and need for clinical documentation.

Completes chart reviews to submit all appropriate documentation to insurance companies for authorization purposes.

Coordinates with third party payers regarding information necessary for appropriate financial processing of patients, including: follow-ups with primary care providers for referrals and authorizations; notifying insurance carriers of admissions; obtaining authorizations and verifying benefits eligibility.

Refers patients/families to Financial Counseling for updated and/or eligibility issues.

Works directly with RN, APRN, and MD level staff to notify of denials requiring further action.

Coordinates with Utilization Review for status designation of Outpatient/Inpatient Admissions.

Coordinates daily assignments and escalates clinic concerns to management team regarding authorization barriers.

Works directly with Insurance Provider Representatives when necessary, in order to have outstanding authorization issues resolved.

Maintains abnormality tracking of outstanding issues, which cause delay and/or denial of authorization.

Financial Counselor:

Interviews patients and/or families, in-person or by phone, to verify complete insurance and financial information, explain financial policies, complete appropriate financial evaluation forms.

Refers patients/ families to DSS and Financial Assistance.

Determines guarantor's propensity to pay non-covered charges, as well as determine potential eligibility for financial assistance programs.

Establishes financial arrangements / payment plans with patients.

Identifies reason(s) for non-payment and follows-up to ensure resolution.

Financial Responsibility:

Responsible to track abnormalities in account registration and report feedback/education to front end users throughout Patient Access, CCMC, and CCSG when necessary.

Verifies insurance plans using the various methods available such as RTE, Web-Based, & Telecommunications.

Investigates patient insurance coverage, facilitates certification, manages process to maximize payment from both commercial and managed care plans.

Follows-up with team member responsible for patient account to resolve outstanding financial issues.

Demonstrates knowledge of the age-related differences and needs of patients in appropriate, specific populations from neonate through adolescence and applies them to practice. Demonstrates cultural sensitivity in all interactions with patients/families. Demonstrates support for the mission, values and goals of the organization through behaviors that are consistent with the CT Children's STANDARDS.

SUPERVISORY RESPONSIBILITIES

May be responsible to coordinate daily activities of the department; delegate assignments to staff; and serve as a primary resource to staff.

First level resource to staff and various leadership regarding daily processes and issues.

Active participant of minimum 1 hospital committee; shares departmental and/or organizational initiatives with team members.

Responsible for ensuring standard work processes are up to date, accurate, and include all pertinent information of performing job duties at staff level.

Direct resource between staff and management in regards to daily operations.

EDUCATION and/or EXPERIENCE REQUIRED

Education Required: High School Diploma, GED, or a higher level of education that would require the completion of high school, is required.

Education Preferred: Bachelors or Associates Degree strongly preferred.

Experience Required: 2-4 years directly related experience required. Healthcare experience required.

Experience Preferred: 1 year of CT Children's direct related experience preferred.

LICENSE and/or CERTIFICATION REQUIRED

CHAA (Certified Healthcare Access Associate) required

CHAM (Certified Healthcare Access Management) preferred and/or discussed

KNOWLEDGE, SKILLS AND ABILITIES STRONGLY PREFERRED

KNOWLEDGE OF

• Advanced knowledge of MS Word and Excel
• ADT systems and Insurance Verification systems (EPIC preferred)
• Knowledge of Managed Care, referral/pre-certification/ authorization, Denials, Patient Accounts and DSS.

SKILLS

• Computer, typing, data entry

• Excellent verbal and written communication skills

• Excellent organizational skills

• Ability to provide constructive feedback to staff

• High organized, with excellent time management and prioritization abilities

• Must have excellent written and verbal etiquette.

ABILITY TO

• Handle a fast paced, high volume environment

• Work in a team environment alongside multiple disciplines

• Coordinate workflows, anticipate and reassign/balance workloads

• Provide continued guidance and training to staff and delegate effectively

• Independently able to have crucial conversations with others/staff

• Independently functions in at least 1-2 additional Patient Access Department

• Prioritize, escalate, and have difficult conversation with medical team members

• Ability to communicate clearly via written emails, charts, etc.