Patient Access Representative

SUMMARY:
Under
the general supervision of the Supervisor, and according to established
policies and procedures, interviews and registers all patients (Inpatient and
Observation, Emergency, and Outpatients) to obtain demographic, third party
insurance and related financial information, and enters to on-line computer
system. Initiates, reviews and follows-up on patient accounts to ensure proper
data collection for billing. Verifies all
demographic and insurance information and obtains referrals as required.
Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.
In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include:
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.
Interviews patient or patient's representative in order to
obtain complete and accurate third party health insurance and related
personal/financial information. Follows-up on missing data by interviewing patients, families or calling
employers, nursing homes and other facilities
Completes registration and enters all data obtained into
hospital computer system. Prepares or
completes records as follows:
Ensures patient is properly identified in system per
department policy. Verifies demographic
and insurance information by asking open-ended questions.
Registers all patients (Outpatient, ED, Inpatient and
Observation) by entering and/or verifying demographic insurance information
into hospital information system. Upgrades account to an active account status.
Completes documentation required on financial clearance
reports as indicated by Patient Advocate or Pre-Registration Office.
Utilizes on line tools and/or telephone to verify coverage,
determine level of benefits, and confirm that the primary care physician (PCP)
matches the PCP that is recorded in hospital system. Contacts insurance carrier or company for
missing information when necessary. Notifies Pre-Registration Office if coverage changes from
pre-admit/pre-registration information.
Identifies primary and secondary insurer. Properly records
insurance information in system. Completes lien forms upon determination that a
liability exists. Enter financial notes
into system.
Gathers paper referrals from patients, when required by the
payer. Updates with the appropriate documentation. Contacts Financial
Counselor/Pre-Registration Office if the insurance does not verify or if the
patient does not have a referral when required by the payer.
Utilizes system to determine self-pay balances for all
patients.
Uses reference tools to determine the expected payment due
at time of service. Contacts Patient Financial Advocate to estimate expected
payment on complex cases. Refers patients to Patient Financial Advocates if
patients cannot meet the expected payment according to defined criteria.
Collects co-payments as required per financial clearance or
as required by third party payor or department policy. This includes cash;
check, credit card payments for ambulatory and Emergency services or as
indicated by Patient Advocates. Documents collections in system, logs payments, provides receipts per
department policy. Completes financial
clearance screens in system.
Explains consent, financial and insurance forms to patients
or designee and provides general hospital information regarding policy and
procedure. Obtains patient signatures on
all required forms to meet established hospital requirements. i.e. Privacy
notice, Patient Agreement, Important Message from Medicare/Tricare, the
Medicare Observation Notice/Moon.
Verifies and updates all information. Makes bracelets, places bracelet on patients
per department policies in accordance with patient identification policy.
Utilizes hospital department scheduling and workflow reports
to complete daily work. Communicates
with service departments to obtain order information as required. Communicates with Financial
Counselor/Pre-Registration Office to obtain authorizations not obtained at, or
prior to, time of service
Asks patient for Advance Directive and includes with
admission paperwork to go to nursing unit, provides patients with information
on Advance Directives if one is not prepared.
Explains and has patient sign Advance Beneficiary Notice
(ABN) as required.
Completes
medical necessity checks utilizing order entry system per hospital policy if
not done during pre-registration process.
Distributes financial aid applications when patient lacks
evidence of adequate health insurance coverage, according to established
criteria. Refers patients to Patient
Financial Advocate to assist patient with applications for medical coverage
(Medicaid, RIte Care, etc.) or Community Free Service, and to establish payment
plans.
May pre-admit/pre-register, scheduled outpatients and
inpatients, in hospital system.
Contacts patient's to verify demographics obtained at time
of scheduling to complete any missing information.
Verifies patient insurance coverage(s), both primary and
secondary, on-line or by telephone.
Obtains and verifies all other information required to
secure payment through sources such as Worker's Compensation, MSP, Medicare
liability, liens, etc.
Ensures referrals are obtained and confirms accuracy of the
PCP.
Establishes level of insurance benefits and expected payment
for selected services. Determines the
patient's portion of payment, when applicable and arrange for payment prior to
the provision of services.
Checks outstanding balances incurred for previous services
prior to contacting patient and follow collection policy concerning prepayment
prior to the provision of additional services.
When appropriate, medical necessity verifications for
services to be provided will be performed by the servicing department and will
also require that ABN's be addressed for payment at the time of
pre-registration.
May collect prepayments by phone or mail, if there is enough
time before admission or the provision of outpatient services to accomplish the
collection, otherwise, instruct patient to bring payment at the time of
admissionrrival.
Refers insured patients who cannot meet their financial
obligations including previously incurred hospital balances, current
admission/outpatient expected non-covered charges and ABN's to Patient
Financial Advocates (in accordance with department policy).
Updates status of financial clearance activities in system.
Preparesssembles all necessary paperwork preparatory to
the patient's arrival.
Reviews/corrects third party payer eligibility reports.
Completes real time status transfers.
At arrival, at admission or in the patient's room, may
complete any missing documentation and paperwork required from patients and/or
family members
Coordinates with Nursing Department to assign patient beds
in accordance with case management guidelines.
Reviews newly assigned medical record numbers for
duplication, reporting all duplicates on appropriate form.
Attends and participates in staff meetings.
May be required as needed to provide coverage to numerous
locations (hospital-based Admitting, ED, Outpatient and Pre-reg areas to meet
patient/customer needs.
Protects and preserves patients right to privacy and
confidentiality.
Utilizes department equipment: i.e. fax machine, phone, visa
machine, laptop PC and other technology as developed.
Performs 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 process preferred. Typing and data entry skills required.
EXPERIENCE:
Customer Service Skills
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.
INDEPENDENT ACTION:
Perform independently within department policies and
practices. Refer specific complex
problems to supervisor where clarification of departmental policies and
procedures may be required.

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:

evening every other weekend and holidays off

Work Shift:

Day

Daily Hours:

8 hours

Driving Required:

No