PAS Revenue Cycle Specialist

Patient Access Services Representative

The purpose of this position is to greet and "arrive" patients presenting to the Emergency department, interview patients to obtain demographic, accident, and financial information in order to facilitate patient care and support front end billing activities. This position supports Oregon Health & Sciences University's mission by providing excellent customer service to every patient, patient families, visitors, and staff who present to any area of the Patient Access Services Department, either in person, via telephone, or over electronic communications.

Function/Duties of Position

Customer Service

• Provides high quality customer service to both external and internal customers that meets or exceeds the service standards of the health care industry.
• Promptly greet all patients, visitors, and others in a warm, courteous, and professional manner, face to face or over the phone.
• Demonstrates the ability to communicate effectively, timely, and respectfully at all times, especially in a high stress environment.
• Provides flexible coverage to assist with internal service needs and the continuous application of process improvement methods and skills.
• Determines customer needs proactively, and direct inquiries to appropriate resources.
• As problems and miscommunications occur with internal or external customers, demonstrates the ability to clarify and resolve problems immediately to avoid further communication breakdowns.
• Demonstrates respect and cooperation in all staff relationships, with a genuine willingness to prevent or resolve inter-personal conflicts.
• Demonstrates knowledge of all department locations, units, and buildings on OHSU Campus.
• Answers multi-line telephone inquiries. Determine caller needs and assist callers efficiently and appropriately.
• Determine priorities and act quickly, make decisions efficiently and in a calm manner in emergency and stressful situations.
• Facilitating all incoming after hours foot traffic into OHSU hospital. This includes providing directions and screening of all patients and visitors.
• Liaison between clinical team, social work and case management for complicated patients and family members.
• Utilizes appropriate interpreter services when necessary.
• Keep patients in lobby area updated.

Patient Registration

• Perform established patient search methods for medical record number in computer database.
• Properly identify and arrive patients that arrive in the ED whether it is a walk in or by ambulance.
• Gathers, adds, updates, and/or verifies detailed demographic information and completed/signed forms required for services. These functions are performed at stationary computer terminals or at patient's bedside using a mobile computer terminal, occasionally over the phone. Hand written documentation may only be utilized during computer downtime or device malfunction.
• Completes Race, Ethnicity, Language, and Disability (REALD) questionnaire with patient face to face or over the phone and updates REALD Smart Form as required by law. Serves as liaison for patients and families with questions.
• Satisfies state regulations to identify support persons for individuals with disabilities.
• Identifies unidentified patients and marks old account for merge, if necessary.
• Corrects patient identity inaccuracies, as identified.
• Accurately complete Inter-Hospital Transfers and same-day admissions and obtain prior medical records as needed.
• Activates direct admissions based on notification from unit at time of patient's arrival.
• Follows Oregon Administrative Rules (OAR's) regarding workers' compensation in operation of OHSU and industry workman's compensation procedures. Provides timely follow up for completion of workman's compensation "827" and DOLI form for work related injuries.
• Initiates and completes claims for worker's compensation injuries, motor vehicle accidents, and crime victim accounts.
• Provides patient education regarding OHSU financial assistance, insurance coordination of benefits, Patient Rights, Terms & Conditions, Advance Directives, Medicare Secondary Payer Questionnaire, Important Message from Medicare, Medicare Outpatient Observation Notice, Champus Message to patients and their representatives, Notice of Privacy Practices, use of patient information and/or specimens in OHSU research, and other facility or regulatory documents.
• Obtains signatures and enters into computer all facility and regulatory required data and forms. Reviews all for accuracy.
• Collect Co-pays/Deposits as required.
• Provides receipts and completes necessary accounting procedures including reconciliation and deposit of funds.
• Determines urgent/emergent medical situations and activates rapid response team or engages the assistance of nursing staff to assist.
• Manage patient valuables process.

Insurance Verification/Financial Clearance

• Gathers, adds, updates, and/or verifies detailed insurance coverage and financial status with each patient over the phone or face to face.
• Creates new and maintains existing insurance coverages/guarantors for a patient based on their insurances and the care being provided.
• Obtains benefit information including deductible or co-pays, co-insurance, stoploss or out of pocket status, and correct billing address.
• Complete insurance verification on each patient's insurance 100% of the time when the insurance verification status says New, Elapsed, Incomplete, Needs Review, or is Medicaid, using electronic verification in RTE, payer portals, or other required methods. The Patient Access Service Staff will also re-verify the eligibility insurance information if the insurance was not verified in the current month.
• Reviews MMIS for all uninsured or single coverage patients
• Refers all non-sponsored patients to Oregon Health Plan (OHP) and provides information for financial assistance, working closely with Financial and Medicaid Services.
• Ensures all required forms are completed for services and confirmation of payment sources.
• As required, notifies payors of admissions to OHSU Facilities for patients that are treated in the Emergency Department, facility-to-facility transfers for higher level of care, or direct admissions.
• Maintains current information on managed care insurance plans and serves as a liaison and information resource for patients, referring physician offices, and other OHSU staff. Applies problem solving and negotiating skills in resolving patient concerns and managed care related issues.
• Maintain knowledge pertaining to insurance issues which include but are not limited to motor vehicle, Worker's Compensation, personal injuries, Medicare, OHP/Washington Welfare/Medicaid, and exposures.
• Collects detailed information of trauma admissions (motor vehicle accident, personal injury, and/or worker's compensation) to determine accident-related liability.
• Maintain access to all insurance website by signing in one time per month, at minimum.

Other duties as assigned.

Required Qualifications

• High School diploma or equivalent; AND
• One year of experience in a medical office setting, including high-volume direct patient contact, scheduling of appointments and registration and/or billing responsibilities. OR
• Two years of work experience in a high-volume direct public contact, front-line non-healthcare setting position.
• Basic computer skills, including word processing and Windows applications.
• Basic computer keyboarding skills including typing of minimum 40 wpm with high accuracy.
• Demonstrated excellent verbal and written communication skills.
• Demonstrated working knowledge around insurances and benefits.
• Strong customer service orientation.
• Ability to walk and stand for 6-10 hours/day, position is extremely mobile.
• Demonstrated effectiveness during extremely confrontational customer interactions in a high stress environment.
• Demonstrated advanced PAS user skills or equivalent as well as extensive knowledge of integrated care models.

Preferred Qualifications

• Prior experience in hospital admissions or ED registration.
• Minimum six months experience as a registrar at OHSU and demonstrated accuracy rate of 97% or greater. As a registrar, must be meeting/exceeding all other individual performance standards in a sustained manner.
• Thorough knowledge of verifying medical insurance, including worker's comp and third party liability.
• OHSU Registration experience.
• Demonstrated efficiency and problem solving in resolving patient concerns.
• Strong attention to detail and processes.
• Ability to work with a high level of accuracy, speed, multitask, and prioritize in high stress/high volume

Oregon Health & Science University (OHSU)