Patient Access Rep - Patient Financial Advocate

Position: Patient Access Representative-U PFA

Department: Patient Access Services

Schedule: Full Time

POSITION SUMMARY:

Ensures that the Labor & Delivery, Main Admissions, Pain Clinic and Surgical Day patient registration and billing information is complete and accurate. Provides support as needed to all clinical staff. Must be able to function in centralized and independent patient care area environments. Performs full registration and obtains, verifies and records personal, demographic, financial and visit-specific clinical information. Prioritizes and multi-tasks in a hectic and fast-paced clinical environment. In addition to registration functions, the Inpatient Financial Advocate provides uninsured and underinsured persons enrollment assistance to access affordable insurance coverage through MassHealth, Out of State Medicaid, Health Safety Net, or BMC's Charity Care Program. The Inpatient Financial Advocate, as a Certified Application Counselor, provides patient advocacy and follow up support to ensure that patients' pending applications are fully completed and submitted for consideration. The team member utilizes patient workqueues to identify and follow-up on self-pay accounts with open financial counseling trackers. As needed, the team member will contact patients by phone, email, or letter to request and obtain signed applications, consent forms, and/or verification documents required to determine eligibility and secure active healthcare coverage. This team member is responsible for ensuring the accuracy of patient information submitted on an application and for tracking the status of the application until a final disposition of eligibility is made. Additionally, they will assist patients in appealing denied applications if requested or applying for the hospital's Charity Care Program as a payer of last resort. The Certified Patient Access Representative will embody BMC's mission, vision, and values and follow policy and procedure regarding BMC's billing and collection practices and the Certified Application Counselor Designation Agreement between BMC and MassHealth. All team members within Patient Access Services are expected to maintain a Quality Assurance score of 95% or greater.

JOB REQUIREMENTS

EDUCATION:

High School Diploma/GED

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

MassHealth's Certified Application Counselor and maintain certification renewal annually required.

EXPERIENCE:

• 2 years of hospital registration or financial assistance related experience OR a minimum of five years customer service experience.

• Bilingual persons and persons with hospital and/or healthcare experience strongly preferred.

KNOWLEDGE AND SKILLS:

• Accuracy and attention to detail

• Ability to work independently and as a part of a team

• Strong customer service and interpersonal skills

• Must be flexible and able to function within a team

• Ability to maintain composure in stressful circumstances

• Basic computer skills and/or competency to learn computer skills required for MS Outlook, Epic and other designated systems.

• Must possess and Demonstrates professionalism, maturity, and confidence needed to work effectively in a diverse, multi-cultural, and decentralized environment.

• Must possess and Displays strong, consistent communication skills, (oral and written), interpersonal skill, and record keeping skills.

• Must possess and Displays strong organizational skills with ability to manage multiple tasks simultaneously; prioritize work assignments appropriately; and complete follow up task timely.

• Must possess and Demonstrates strong work ethic and ability to meet performance goals for productivity and outcomes with minimal direct supervision.

• Must possess and Demonstrates critical thinking and sound judgment in addressing and resolving barriers, issues, or concerns identified.

• Requires strong technical computer skills and proficiency in utilizing Epic and external database systems to research cases and successfully assist patients in securing active coverage.

• Must possess and Displays exceptional customer skills and the ability to engage patients, family members, and team members respectfully, with empathy and cultural sensitivity.

SPECIAL WORKING CONDITIONS

Patient Access Services covers areas that are open 24/7/365.

ESSENTIAL RESPONSIBILITIES / DUTIES:

• Delivers outstanding customer service to both internal and external customers.

• Ensures the integrity of the data in the hospital's information system with respect to patient demographic, insurance and admission information.

• Verifies patient insurance using various methods.

• Applies knowledge of payer requirements and guidelines to ensure effective reimbursement.

• Assists in ensuring adequate departmental coverage when needed. This includes covering in the Admitting or Emergency Department at the direction of the Admitting Manager.

• Participates in holiday coverage rotation.

• Conducts patient interviews.

• Secures patient valuables.

• Documents accurate information on all patient accounts to ensure an effective workflow throughout the organization.

• Demonstrates ability to handle difficult situations by using effective problem solving skills.

• Serves as a resource for patients and others with questions regarding registration, insurance eligibility and patient admission.

• Collects insurance copays from patients.

• Collaborates with others to ensure a positive and effective patient experience.

• Demonstrates ability to work independently and as part of a team in a fast paced environment with constant interruption.

• Flexible availability to accommodate work coverage requests.

• Able to accurately type at least 40 words per minute.

• Relates effectively to various types of customers in a professional and courteous manner.

• Utilizes supervisor or manager to resolve issues/concerns as needed.

• Attends and participates in departmental meetings.

• Commits to recognize and respect cultural diversity for all customers (internal and external).

• Communicates effectively with internal and external customers with respect of differences in cultures, values, beliefs and ages, utilizing interpreters when needed.

• Demonstrates respectful personal conduct and use of AIDET when engaging patients and other team members.

• Completes MassHealth's curriculum for Certified Application Counselor and renews certification annually.

• Utilizes Work Ques to identify patient accounts requiring follow up assistance to complete pending applications.

• Contacts patients by phone, email, and/or letter through USPS to obtain required verification documents to complete and submit applications for enrollment. As needed, uses interpreter services to communicate in a language best understood by patients.

• Tracks status of submitted applications until processed with a final disposition. Verifies and updates active insurance on all accounts with covered dates of services, closes financial tracker, and documents final disposition of application in electronic medical record system.

• Secures retro-active coverage from MassHealth for non-covered dates of service in accordance with regulations.

• Contacts MassHealth and other out of state Medicaid providers to review pending cases or request that applications be expedited.

• As appropriate, assists patients in appealing denied applications.

• For patients determined ineligible for public entitlement programs or QHPs, screens for eligibility through BMC's Charity Care Program, (CCP).

• Assists patients in applying for BMC Charity Care Program. Obtains signed applications and required verification documents to process and determine patients' eligibility for free or reduce care. Updates patient accounts with billing indicator, CCP Pending, to temporarily disable applicable accounts from further billing action, pending a final determination of eligibility.

• Processes CCP applications and issues written notifications regarding patient's application status, (i.e. Approved or Denied).

• If "Approved," removes pending billing indicator, updates accounts with CCP coverage, and adjusts balances according to patients' determined eligibility status.

• If "Denied," removes CCP Pending billing indicator, updates accounts to Self-Pay to ensure that Self-Pay discount is applied. Contacts patients, in writing and by phone, to discuss payment options and assist in establishing a payment plans

• Collects and posts payments on patient accounts with outstanding balances.

• Utilizes protected software programs to track pending applications and verify approvals for MassHealth, Health Safety Net, and ConnectorCare.

• Responds to billing questions and advises patients on options available to resolve account balances, (i.e. payment plans, self-pay discount, and BMC Charity Care Program).

• Submits written reports of work activity as requested and in a timely manner; completes daily, weekly and/or monthly statistics to document the volume of patients encountered, and number of successful enrollments or denied applications.

• Demonstrates superior customer service standards.

• Participates in regular staff meetings and scheduled trainings as required to meet or exceed established, qualitative goals for productivity and core competencies.

• Provides pricing estimates for elective services, as requested, if patient is uninsured or if services are uncovered by payer.

• Under the direction of a Manager, assists with orientation and training of new staff as assigned.

• Understands and adheres to rules established by the BMC Credit and Collection Policy.

• Protects patient and family confidentiality.

• Review all identified quality assurance errors and remedy within 48 hours of notification.

• All other duties as assigned. IND123

(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required).

Equal Opportunity Employer/Disabled/Veterans