Current Department Employees: Patient Access Representative Lead

Lead Patient Access Representative

Bargaining Unit: EA

Rate of Pay: DOE

Summary Serves as the Lead Patient Access Representative for assigned team members in the absence of department management. This position performs imperative duties including but not limited to appointment scheduling, registration, insurance verification, telephone coverage, patient collections, and customer service. Plays a key role in process improvement and operational training of new team members.

Hours and Place of Work: Required to be available for standby. Scheduled to work in Truckee and IVCH facilities as needed.

Essential Duties and Responsibilities

• Responsible for maintaining open lines of communication with staff throughout the day.
• Responsible for coordinating the day-to-day operations insuring all responsibilities are performed.
• Assigns duties to team members and ensures tasks are completed accurately and timely.
• Maintains up to date materials in work area.
• Participates actively in department meetings and leads team meetings when assigned.
• Leads team huddles and ensures huddles take place in Lead's absence.
• Acts as point person for department communications to assigned service area.
• Assists in updating policies and procedures as necessary
• Responsible for maintaining supply levels and ordering as necessary
• Responsible for obtaining staff for absences and/or additional staffing needs
• Contribute to the creation of a positive team environment, acknowledge team members for a job well done and consistently demonstrate integrity, honesty, kindness, courtesy, cooperation and sensitivity toward patients, co-workers and other contacts.
• Identifies areas for needed process improvement. Facilitates education and implementation of assigned tasks.
• 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 resources.
• 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.
• Signs patients up for hospital presumptive eligibility (HPE).
• Holds sufficient understanding of insurance protocols for orders, authorizations, referrals, copayments, 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. Provides MOON notice to patients in the absence of a Financial Counselor.
• 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.
• Works on special projects as assigned.
• Acts as subject matter expert on assigned quality checks, reports, and audits for department.
• Completes service area specific training and ongoing training in their service area including training on error trends
• Reviews their service area specific SOP's on a quarterly basis. Provides suggested updates to the Registration Coordinator team on SOP's.
• Works in collaboration with the Registration Coordinator team on onboarding new team members into their service area, including; ensuring training needs are being met, trainee has appropriate setup and resources, validates, and competency checks new team members, and completes additional training as requested by Patient Access Management which may include non-service area training.
• Communicates progress of trainee to Patient Access leadership, Registration Coordinators, and other trainers. Develops training plans when requested.
• Works in collaboration with the Registration Coordinator team on remedial training for team members.
• Attends and actively participates in training of operational trainers. Stays current on all training methods and tasks. Participates in continuing education of operational trainers.
• Provides constructive criticism and direction to team