Patient Access Representative

Patient Access Representative I OR II

Eligible for shift differential pay when working evening, night, or weekend shifts. Bargaining Unit: EA. Rate of Pay: Patient Access Rep I - $25.78/HR + DOE. Patient Access Rep II - $28.46/HR + DOE. Under the general supervision of the Patient Access Director, this position performs imperative duties including but not limited to appointment scheduling, registration, insurance verification, telephone coverage, patient collections, registration follow up, and customer service. Acts a trainer and/or subject matter expert for team. Required to be available for standby. Scheduled to work in Truckee and IVCH facilities as needed.

Essential Duties and Responsibilities:

• Registers patients by verifying identity and interviewing patient or representative in a pleasant, professional, and timely manner according to department practices.
• Ensures all necessary demographic and financial data is obtained and accurately entered into the electronic health record (EHR).
• Scans all necessary insurance information, including insurance cards, personal identification, driver's license, physician order, etc. into EHR.
• Validates existing data related to prior registrations by asking patient to repeat all data and updating appropriately in the EHR.
• Identifies appropriate payor sources and verifies eligibility according to department procedure for all patients.
• Checks to ensure authorization has been obtained prior to services being rendered. If authorization is not in place, follows Financial Clearance policy. Creates and discusses Intent to Proceed with a Non-Authorized Service forms as needed. Scans all appropriate documentation into the EHR.
• Refers all private pay and underinsured patients to the Financial Counselors or Eligibility Advocate.
• Initiates patient financial conversations with respect and privacy. Creates estimates for services and delivers to patient. Collects estimated amount due per TFH Financial Clearance Policy. Documents all estimates, conversations, and collections in EMR.
• Understands and can explain hospital payment options to patients.
• Holds sufficient understanding of insurance protocols for orders, authorizations, referrals, co-payments, deductibles, allowed amounts, etc.
• Maintains and updates knowledge regarding all types of insurance and healthcare coverage, utilizing reference materials provided, when necessary.
• Understands and follows all regulatory requirements including but not limited to: Emergency Medical Treatment and Labor Act (EMTALA), Health Insurance Portability and Accountability (HIPAA), and Red Flag Rules.
• Performs alternate provider workflow for not on staff providers including, NPI check and OIG Exclusion List checks. Documents all information in EHR.
• Informs patients of and obtains signatures timely for all registration forms including but not limited to: Conditions of Admission, Guide to Billing and Financial Assistance, Patient Rights and Responsibilities, Notice of Privacy Practices, Acknowledgment of Patient Information on Advance Directives, Important Message from Medicare, and California Observation Notice.
• Possesses knowledge of and can explain all forms, required registration information, and procedures as needed.
• Creates armbands, labels and other documentation as necessary. Places armbands on patients following appropriate policy and procedure.
• Obtains worker's compensation accident information when applicable. Calls patient employer to verify employment. Obtains all insurance information from employer timely. Contacts insurance company to gather claim information. Enters all information into EHR.
• Performs cashier functions for all patients who present cash, check or credit card as payment for services. Requests, processes, and deposits all payments per department cash handling policy to promote stewardship of District resources.
• Completes Medicare Secondary Payor Questionnaire and documents responses in EHR.
• Uses EMR to check local coverage determinations for Medicare patients as needed. Generates and produces Advanced Beneficiary Notices (ABN's). Delivers to patients and documents in EMR.
• Assists patients with filling out medical records release forms. Verifies patient identity and documents on forms. Sends all Release of Information (ROI) forms to Health Information Management (HIM).
• Schedules patients for walk-in services. Assists in scheduling patients at check out.
• Utilizes patient schedules to prepare for patient appointments when possible including but not limited to: missing registration items, patient estimates, forms, schedules, and notes.
• Promptly answers phone calls at work station and directs to appropriate area as necessary. Acts as District operator coverage outside of business hours or as needed.
• Displays exceptional customer service with patients, visitors, and peers at all times by addressing and treating all with respect and understanding.
• Attends and engages in department meetings, projects, teams, trainings, and committees.
• Utilizes interpreter service to communicate with patients when needed.
• Performs quality checks, reports, audits, note-taking, and other clerical tasks for department when requested.
• Keeps all applicable certifications active. Provides proof of certifications when requested. Ensures current certification are on file in Human Resources. Works EMR work queues during each shift. Follows up on all items including: pre-registration and pre-admission missing registration items, emergency room visit missing registration items, appointment missing registration items, admission missing registration items, discharged patient missing registration items, returned mail, claim edits, stop bills, and discharged-not-billed checks.
• Checks email several times during shift and responds appropriately.
• Completes all job functions with discretion ensuring patient privacy.
• Stores patient's valuables and documents appropriately.
• Responds to emergency calls and pages emergency announcements in accordance with emergency response policies.
• Performs hospital front desk duties. Receives visitors, obtains name and nature of business, and provides information and direction.
• Works shift and area as assigned on schedule. Is cross trained in different coverage areas of Patient Access when requested.
• Enters safety, feedback, and disruptive event reports as needed.
• Displays critical thinking at all times.
• Actively looks for solutions and shares ideas for improvement with team.
• Maintains proactive and positive communication with management team, peers, and patients at all times.
• Exhibits professionalism in appearance, speech and conduct following department dress policy at all times while on shift.
• Acts as leader of assigned inter-department committee or team. Is responsible for deliverables in moving team forward.
• Works on special projects as assigned.
• Acts as subject matter expert on assigned quality checks, reports, and audits for department.
• Acts as mentor and operational trainer to new team members in conjunction with Registration Coordinators. Trains, validates, and competency checks new team members. Communicates progress of trainee to Supervisors and Registration Coordinators.
• Attends and actively participates in training of operational trainers. Stays current on all training methods and tasks. Participates in continuing education of operational trainers.
• Demonstrates System Values in performance and behavior.
• Complies with System policies and procedures.
• Other duties as may be assigned.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Supervisory Responsibilities:

No supervisory responsibilities.

Education and Experience:

High school diploma or general education degree (GED) required; Associate's or Bachelor's degree in healthcare administration, business administration or related field desired. One to two years patient registration experience preferred or equivalent combination of education and experience.

Licenses, Certifications:

Required: CHAA Certified Healthcare Access Associate (Required for Patient Access Representative II)

Required: CPR certification within six months of employment or for employees hired prior to 5/17/2019 by 12/1/2019.

Preferred: None

Other Experience/Qualifications:

Customer Service experience preferred.

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.