Patient Access Representative

Summary:

Under

the general supervision of the Supervisor and according to established

policies and procedures interviews and registers all patients (Inpatient and

Observation Emergency and Outpatients) to obtain demographic third party

insurance and related financial information and enters to on-line computer

system. Initiates reviews and follows-up on patient accounts to ensure proper

data collection for billing. Verifies all

demographic and insurance information and obtains referrals as required.

Responsibilities:

Greets

and directs all patients families and visitors in a prompt and courteous

manner.

Interviews patient or patient's representative in order to

obtain complete and accurate third party health insurance and related

personal/financial information. Follows-up on missing data by interviewing patients families or calling

employers nursing homes and other facilities

Completes registration and enters all data obtained into

hospital computer system. Prepares or

completes records as follows:

Ensures patient is properly identified in system per

department policy. Verifies demographic

and insurance information by asking open-ended questions.

Registers all patients (Outpatient ED Inpatient and

Observation) by entering and/or verifying demographic insurance information

into hospital information system. Upgrades account to an active account status.

Completes documentation required on financial clearance

reports as indicated by Patient Advocate or Pre-Registration Office.

Utilizes on line tools and/or telephone to verify coverage

determine level of benefits and confirm that the primary care physician (PCP)

matches the PCP that is recorded in hospital system. Contacts insurance carrier or company for

missing information when necessary. Notifies Pre-Registration Office if coverage changes from

pre-admit/pre-registration information.

Identifies primary and secondary insurer. Properly records

insurance information in system. Completes lien forms upon determination that a

liability exists. Enter financial notes

into system.

Gathers paper referrals from patients when required by the

payer. Updates with the appropriate documentation. Contacts Financial

Counselor/Pre-Registration Office if the insurance does not verify or if the

patient does not have a referral when required by the payer.

Utilizes system to determine self-pay balances for all

patients.

Uses reference tools to determine the expected payment due

at time of service. Contacts Patient Financial Advocate to estimate expected

payment on complex cases. Refers patients to Patient Financial Advocates if

patients cannot meet the expected payment according to defined criteria.

Collects co-payments as required per financial clearance or

as required by third party payor or department policy. This includes cash;

check credit card payments for ambulatory and Emergency services or as

indicated by Patient Advocates. Documents collections in system logs payments provides receipts per

department policy. Completes financial

clearance screens in system.

Explains consent financial and insurance forms to patients

or designee and provides general hospital information regarding policy and

procedure. Obtains patient signatures on

all required forms to meet established hospital requirements. i.e. Privacy

notice Patient Agreement Important Message from Medicare/Tricare the

Medicare Observation Notice/Moon.

Verifies and updates all information. Makes bracelets places bracelet on patients

per department policies in accordance with patient identification policy.

Utilizes hospital department scheduling and workflow reports

to complete daily work. Communicates

with service departments to obtain order information as required. Communicates with Financial

Counselor/Pre-Registration Office to obtain authorizations not obtained at or

prior to time of service

Asks patient for Advance Directive and includes with

admission paperwork to go to nursing unit provides patients with information

on Advance Directives if one is not prepared.

Explains and has patient sign Advance Beneficiary Notice

(ABN) as required.

Completes

medical necessity checks utilizing order entry system per hospital policy if

not done during pre-registration process.

Distributes financial aid applications when patient lacks

evidence of adequate health insurance coverage according to established

criteria. Refers patients to Patient

Financial Advocate to assist patient with applications for medical coverage

(Medicaid RIte Care etc.) or Community Free Service and to establish payment

plans.

May pre-admit/pre-register scheduled outpatients and

inpatients in hospital system.

Contacts patient's to verify demographics obtained at time

of scheduling to complete any missing information.

Verifies patient insurance coverage(s) both primary and

secondary "on-line" or by telephone.

Obtains and verifies all other information required to

secure payment through sources such as Worker's Compensation MSP Medicare

liability liens etc.

Ensures referrals are obtained and confirms accuracy of the

PCP.

Establishes level of insurance benefits and expected payment

for selected services. Determines the

patient's portion of payment when applicable and arrange for payment prior to

the provision of services.

Checks outstanding balances incurred for previous services

prior to contacting patient and follow collection policy concerning prepayment

prior to the provision of additional services.

When appropriate medical necessity verifications for

services to be provided will be performed by the servicing department and will

also require that ABN's be addressed for payment at the time of

pre-registration.

May collect prepayments by phone or mail if there is enough

time before admission or the provision of outpatient services to accomplish the

collection otherwise instruct patient to bring payment at the time of

admission/arrival.

Refers insured patients who cannot meet their financial

obligations including previously incurred hospital balances current

admission/outpatient expected non-covered charges and ABN's to Patient

Financial Advocates (in accordance with department policy).

Updates status of financial clearance activities in system.

Prepares/assembles all necessary paperwork preparatory to

the patient's arrival.

Reviews/corrects third party payer eligibility reports.

Completes real time status transfers.

At arrival at admission or in the patient's room may

complete any missing documentation and paperwork required from patients and/or

family members

Coordinates with Nursing Department to assign patient beds

in accordance with case management guidelines.

Reviews newly assigned medical record numbers for

duplication reporting all duplicates on appropriate form.

Attends and participates in staff meetings.

May be required as needed to provide coverage to numerous

locations (hospital-based Admitting ED Outpatient and Pre-reg areas to meet

patient/customer needs.

Protects and preserves patients right to privacy and

confidentiality.

Utilizes department equipment: i.e. fax machine phone visa

machine laptop PC and other technology as developed.

Performs other related duties as required to support the

operations of the Department.

Other information:

BASIC KNOWLEDGE:

High school diploma or equivalent. Knowledge of medical terminology third party

insurance information and standard office computer applications required. Knowledge of third party payer verification

and authorization process preferred. Typing and data entry skills required.

EXPERIENCE:

Customer Service Skills

Six to twelve months previous third party billing or

hospital registration experience. Third

party billing knowledge. Data entry

skills and PC experience required.

WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:

Sitting for long periods of time at a workstation requiring

the continuous use of a computer and telephone. May have to do moderate to excessive walking depending on the location

of the assignment. Ability to lift up to

10 pounds.

INDEPENDENT ACTION:

Perform independently within department policies and

practices. Refer specific complex

problems to supervisor where clarification of departmental policies and

procedures may be required.

Lifespan is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status. Lifespan is a VEVRAA Federal Contractor.

Location: Newport Hospital USA:RI:Newport

Work Type: Part Time

Shift: Shift 2

Union: Non-Union