Patient Access Representative II

Description Full-time 8am-5pm JOB SUMMARY: The Patient Access Services Representative II is responsible for independently managing patient registration, insurance verification, and customer service functions. The representative at this level is expected to have a thorough understanding of patient access workflows and manage more complex situations. In addition to performing all outpatient and inpatient registration functions including hospital cashiering and insurance verification. Ensures that patients meet financial requirements. Provides general information to hospital users, patients, and families. Communicates effectively to service delivery areas to maximize patient flow and customer service. Provides excellent patient focused customer service. EDUCATION, CREDENTIALS & EXPERIENCE REQUIREMENTS: Associate degree from an accredited college or University is required. Minimum of six (6) years medical office experience required. Complete the competency check List at 30 days, 3-month and 6-month intervals, with the expectation of demonstrating mastery of job skill outlined for each area. (ER, MCMC, MDC, Rehab) Previous experience with health insurance and patient billing required.? degree from an accredited college or University is required. Completion of medical terminology course required. Ability to train, mentor, and support junior staff. Proficient in registration process and electronic health records (EHR) at Hospital Authority of Miller County GENERAL REQUIREMENTS: Performs all job responsibilities in alignment with the mission and vision of the organization. Performs other duties as required and completes all job functions as per departmental policies and procedures. Maintains current knowledge in present areas of responsibility (i.e., self-education, attends ongoing educational programs). Attend staff meetings and complete mandatory in-services and requirements and competency evaluations on time. Wear protective clothing and equipment as appropriate. GENERAL SKILLS: Ability to communicate in English, both verbally and in writing. Additional languages preferred. Strong written and verbal skills. Basic Computer Skills WORKING CONDITIONS General environment: Works in a well-lighted, air-conditioned area, with moderate noise levels. May be exposed to high noise levels and bright lights. May be exposed to limited hazardous substances or body fluids, or infectious organisms. May be required to change from one task to another or different nature without loss of efficiency or composure. Periods of high stress and fluctuating workloads may occur. May be scheduled as needed including overtime. PHYSICAL REQUIRMENTS & DEMANDS: Have near normal hearing: Hear alarms/telephone/normal speaking voice. Have near normal vision: Clarity of vision (both near and far), ability to distinguish colors. Have good manual dexterity. Have good eye-hand foot coordination. Ability to perform repetitive tasks/motion. Continuously within shift (67-100%): Standing, Walking. Frequently within shift (34-66%): Bending/Stooping, Pushing/Pulling, Lift/carry up to 20lbs, Lift/carry greater than 20 lbs. with assistance. Occasionally within shift (1-33%): Sitting, Climbing, Twist at waist, Lift/Carry greater than 50 lbs. with assistance, Reaching above shoulder. MISSION STATEMENT: QUALITY HEALTHCARE: In our continuing effort to enhance the quality of life for the communities we serve, the Hospital Authority of Miller County is committed to the delivery of superior, safe, cost-effective healthcare through the provisions of education prevention, diagnosis, and treatment. JOB SPECIFIC COMPETENCIES: Responsible for obtaining necessary demographic and financial data through patient interviews, the centralized scheduling system and system queries to complete the pre-registration process. Assures all check-in procedures are completed, and monitors patient wait times, communicating changes to the patient, as necessary. Reads and interprets insurance responses. Communicates financial obligations to patients and collects fees at time of service as appropriate. Accurately performs medical record maintenance and releases. Performs cash posting following department guidelines. Abides by organizational and HIPAA guidelines, privacy practices, patient confidentiality and patient rights. Must maintain high regard for confidentiality. Notifies patient or guarantor of anticipated financial responsibility including copays, deductibles, or coinsurances and collects accordingly. Performs cash posting following department guidelines. Communicates the purpose of and completes all necessary regulatory forms with patient. Completes patient's visit by scheduling any necessary follow-up appointments to include any specialty or ancillary services as possible. Documents financial arrangements. Assist with departmental workflow as needed. Communicates with Physician Offices, Staff, and other departments. Familiar with Advance Beneficiary Notice, Medicare Secondary Questionnaire, Medicare Outpatient Observation Notice, Important Message from Medicare, precertification, ICD-10 coding, Medical Terminology. Identifies patients who require early financial counseling intervention. Maintains knowledge of departmental applications i.e., CERNER, Relias, Heartland, Hometown Health, GAMMIS, Availity, my ABILITY, and other systems utilized by Patient Access Services. Multiple tasks and responsibilities. I must pay attention to detail. Ability to perform efficiently and effectively under stress. Adherent to Strict EMTALA guidelines in financial data collection and collection of co-pays are followed. Strong teamwork between the clinical staff and the financial staff is required. Strong teamwork, communication and customer service skills are required. Handles a high volume of incoming calls. Responds to questions and concerns and directs them to an appropriate location or department. Responsible for reviewing hospital outpatient service orders for accuracy and medical necessity when required. Performs all other duties and projects assigned. Presents consent forms and notifications to patients and obtains all necessary patient signatures and information at time of arrival. May initiate and perform administrative duties to ensure efficient daily business operations, including participating in the office/department opening and closing procedures, assisting with maintaining, ordering, and restocking front office supplies, and receiving and distributing mail. Assist Supervisor and/or Manager with development of staff by being available to teammates, acting as a resource to help complete complicated/complex tasks, providing on the job training to team, and seeking out opportunities to become actively involved in staff workflow and development. Additional Responsibilities: May be separate from PAR Duties Auditing and Quality Review In addition to core registration responsibilities, the Patient Access Representative will perform regular audits and quality checks to ensure accuracy, compliance, and optimal patient experience. The following auditing duties are included in this role: Auditing Responsibilities: Insurance Verification and Accuracy: Review and verify insurance information for all Inpatient and Swing Bed admissions to ensure accurate and up- to-date coverage is documented. Required Documentation Compliance: Confirm that all required patient forms, including but not limited to the MOON (Medicare Outpatient Observation Notice) form, have been properly signed by the patient or their guarantor. Primary Care Provider Accuracy: Audit patient records to ensure that the Primary Care Physician (PCP) listed is accurate and updated in the system. Medicare Secondary Payer(MSP) Questionnaires: Ensure that MSP questionnaires are completed and accurate, with appropriate documentation and any necessary follow- up completed in a timely manner Medicare and Medicaid Eligibility Checks For all patients listed with Medicare or Medicaid, verify eligibility and confirm there are no active Medicare Advantage or Medicaid CMO (Care Management Organization) plans that would alter billing or coverage Portal Consent for Underage Patients Audit portal consents for patients under age 18 to ensure proper authorization and that access limitations for minors are observed in accordance with privacy regulations. Portal Enrollment Confirmation Review patient portal consent forms to ensure patients who opted to sign up were successfully sent an invitation and access link. Investigate and resolve any issues preventing access. PROFESSIONAL REQUIREMENTS: Follows Code of Conduct policy. Adheres to dress code; appearance is neat and clean. Completes annual educational requirements. Maintains regulatory requirements. Always maintain patient confidentiality. Reports to work on time and as scheduled; completes work within designated time. Wears identification when on duty; use computerized time clock system correctly. Completes in-services and returns in a timely fashion. Attends annual review and/or skills fair and department in-services, as scheduled. Attempts to end conversations and other interactions in a positive manner leave others with a good impression of the Hospital Authority of Miller County and its employees. Complies with all organizational policies regarding ethical business practices. Communicates the mission statement of the organization. GUEST RELATIONS STANDARDS: (All guest relation violations are subject to disciplinary action up to and including termination): Always treat others in a friendly, helpful manner. Refers co-workers to proper sources when unable to provide an answer. Interact with others in a professional and friendly manner. Takes interest in others and always gives full cooperation to fellow workers. Always maintains an open line of communication with other departments. Thoroughly familiar with the hospital and the services it offers. OTHER: Responsibility to Report: It is the responsibility of every employee of HAMC to comply with federal, state, and local laws and regulations, as well as HAMC Policies and Procedures. Every employee is held accountable to participate in, comply with and report concerns to his or her supervisor or the Compliance Officer if illegal or unethical behavior is suspected. As an employee of HAMC, you have been granted user access to applicable ePHI systems based on your position. This user or role-based access is intended to give you the minimum necessary access to perform your job function(s) only and should be used only as applicable. OTHER DUITIES: Please note this job description is not designed to cover or contain a comprehensive list of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. #J-18808-Ljbffr