Patient Access Representative

Patient Access Representative

We are searching for a Patient Access Representative to generate clean bills for primary, secondary and tertiary payers, maximize upfront collections, minimize exposure of accounts at risk, ensure clean account receivable balances, maximize self pay collections, and effectively manage the interdepartmental workflow within the revenue cycle.

Duties include but are not limited to:

• Ensures patients and relatives are interviewed to obtain necessary personal and financial information needed for admission/registration of the patient.
• Verifies insurance benefits of the patient and fully documents the verification process in the system.
• Performs all admitting/registration activities to ensure that complete and accurate information is entered into the system in a timely manner.
• Implements policies and procedures for admission/registration of all patients.
• Ensures that eligibility is re-verified when applicable. (e.g. Medicare and Medi-Cal patients)
• Ensures that daily census is accurate, in both paper and system formats. Accuracy includes patient location and program type codes.
• Completes all required forms for admission/registration of a patient and ensures that all required documentation is given to the patient and/or patient's family.
• Enters complete and accurate documentation into the system describing all patient related admitting/registration activities.
• Ensure that all patients have been given full information related to their estimated financial responsibilities to the hospital.
• Ensures that estimated out-of-pocket requirements have been appropriately calculated and entered into the system.
• Collects the estimated out-of-pocket requirements prior to the patient's discharge.
• Fully documents all collection efforts into the system.
• Reviews the out-of-pocket yield report daily to ensure that collection efforts meet the hospital-specific target for upfront collections.
• For situations of financial difficulties, ensures that patients are given applicable information related to payment options, such as the healthcare credit line, time payments and information related to the hospital's financial assistance processes. Ensures that these financial arrangements are finalized prior to the patient's discharge.
• Monitors eligible days/visits and disseminates relevant information to clinical staff, MDs, other Revenue Cycle related departments and Administration in a timely manner.
• Ensures full communication is given to patients of eligible days/visits and "At-Risk" notification is given to patients or the patient's guarantor, in writing when applicable in a timely manner.
• Monitors all information related to actual denial activity and disseminates relevant information to clinical staff, MDs, other Revenue Cycle related departments and Administration.
• Prepares requests for adjustments, refunds, transfers when needed to accurate reflect appropriate AR balances and submits for approval.
• Fully documents all transaction requests into the system.
• Monitors all self pay accounts to ensure patients have been quoted applicable self-pay rates and that accounts are appropriately contractualized to the self-pay rate.
• Monitors all self-pay balances of patients on time payment plans to verify compliance with the program and contact the patient if non-compliance occurs to make further arrangements to bring the account current.
• Ensures all collection activities are in compliance with State and Federal collection laws.
• Demonstrates understanding of the various "Self Pay" account classifications and their applicable patient statement processes.
• Review all self-pay balances with credit balances to ensure the balance is accurate and processes all refunds (both by check and credit card) for approval in a timely manner.
• Works effectively with Assessment & Referral staff to maximize all pre-admission activities.
• Works effectively with Case Management staff to minimize the potential for clinical denials.
• Works effectively with the Centralized Business Office to maximize the overall collection efforts of the hospital.