Patient Access Rep

SUMMARY

Under the general supervision of the Supervisor, and according to established policies and procedures, interview and register all patients (Inpatient, Observation, Emergency, and Outpatients) to obtain demographic, third party insurance and related financial information, and enter it into the online computer system. Initiate, review and follow‑up on patient accounts to ensure proper data collection for billing. Verify all demographic and insurance information and obtain referrals as required. Brown University Health employees are expected to successfully role‑model the organization’s values of Compassion, Accountability, Respect, and Excellence, guiding our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors that guide how we work together and get things done: Instill Trust and Value Differences, Patient and Community Focus, and Collaborate.

RESPONSIBILITIES

Greets and directs all patients, families and visitors in a prompt and courteous manner. Interview patient or patient’s representative to obtain complete and accurate third party health insurance and related personal/financial information. Follow‑up on missing data by interviewing patients, families or calling employers, nursing homes and other facilities. Complete registration and enter all data obtained into the hospital computer system. Prepare or complete manual records as follows: ensure patients are properly identified in the system per department policy, verify demographic and insurance information by asking open‑ended questions, register all patients (Outpatient, ED, Inpatient and Observation) by entering and/or verifying demographic insurance information into the hospital information system, upgrade account status to active, complete documentation required on financial clearance reports as indicated by Patient Advocate or Pre‑Registration Office, utilize online tools and/or telephone to verify coverage, determine levels of benefits, confirm the primary care physician matches the PCP recorded in the hospital system, contact insurance carriers when necessary, notify Pre‑Registration Office if coverage changes from pre‑admit/pre‑registration information, identify primary and secondary insurers, record insurance information properly in the system, complete lien forms upon determination that a liability exists, enter financial notes into the system, gather paper referrals when required by the payer, update SMS with appropriate documentation, contact Financial Counselor/Pre‑Registration Office if the insurance does not verify or if the patient does not have a referral, utilize the system to determine self‑pay balances, use reference tools to determine expected payment due at the time of service, contact Patient Financial Advocate to estimate expected payment on complex cases, refer patients to Patient Financial Advocates if patients cannot meet the expected payment per defined criteria, collect co‑payments as required per financial clearance or third party payer or department policy (cash, check, credit card payments for ambulatory and Emergency services), document collections in the system, log payments, provide receipts, complete financial clearance screens, explain consent, financial and insurance forms to patients, obtain signatures on all required forms (Privacy notice, Ethics brochures, Patient Rights, Hospital Directory, The Miriam Hospital Welcome Brochures), generate patient registration record and plate, verify and update all information, make required plates, bracelets, and face sheets, place bracelet on patients per department policies in accordance with patient identification policy, utilize department scheduling and workflow reports to complete daily work, communicate with service departments for order information, communicate with Financial Counselor/Pre‑Registration Office for authorizations not obtained prior to service, ask patients for Advance Directive and include with admission paperwork, provide information on Advance Directives if none are prepared, explain and obtain patient sign on Advance Beneficiary Notice (ABN) as required, complete medical necessity checks using order entry system per hospital policy, distribute Payment Policy brochures when patients lack adequate health insurance coverage, refer patients to Patient Financial Advocate for coverage applications (Medicaid, RIte Care, etc.) and establish payment plans, notify physicians’ offices by phone or fax of patient arrival to Emergency Department or admission to hospital per policy, upgrade Observation to Inpatient accounts per policy, pre‑admit/register scheduled outpatients and inpatients, verify insured patient demographics at scheduling, verify insurance coverage(s) online or by telephone, obtain and verify all information to secure payment through sources such as Worker's Compensation, MSP, Medicare liability, liens, etc., ensure referrals are obtained and confirm PCP accuracy, establish insurance benefits level and expected payment for services, determine patient portion of payment and arrange for payment prior to services, check outstanding balances prior to contact and follow collection policy, perform medical necessity verifications when required, collect prepayments by phone or mail if time allows, refer insured patients who cannot meet financial obligations to Patient Financial Advocates, update status of financial clearance activities, prepare all necessary paperwork before patient arrival, review and correct third party payer eligibility reports, complete real‑time status transfers, authorize occupancy and collect payment for private room differentials, review bed transfer list daily to authorize and collect all appropriate private room transfers, monitor in‑house accounts for open patient balances, track Medicare days and Lifetime Reserve Days when applicable, negotiate payment before discharge and/or visit patient rooms as required, review all accounts before discharge to clear patients financially or direct them to Patient Advocates, provide bed control by assigning patient to appropriate room, coordinate with Nursing Department to assign beds, explain private room request policy and collect deposits when applicable, monitor bed tracking system for availability and status, coordinate bed cleaning with ESD department, review newly assigned medical record numbers for duplication and report duplicates, attend and participate in staff meetings, provide coverage to various hospital locations as needed to meet patient/customer needs, protect and preserve patient privacy and confidentiality, utilize department equipment (fax machine, phone, visa machine, laptop PC and other technology as developed), and perform other related duties as required to support the operations of the Department.

MINIMUM QUALIFICATIONS

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 processes preferred. Typing and data entry skills required. EXPERIENCE: 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. Pay Range $18.13 - $29.90 EEO Statement Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment. Location The Miriam Hospital - 164 Summit Ave Providence, Rhode Island 02906 Work Type every other weekend 7 hours Work Shift Variable Daily Hours Per Diem - As required Driving Required No #J-18808-Ljbffr Lifespan