Patient Access Associate III - Central Financial Clearance - 40hrs

Job Title

Under limited supervision, independently coordinates and performs multiple complex functions within the Patient Access department.

Responsibilities

Administrative:

• Following department protocol provides general receptionist, secretarial support or Health Unit Coordinator functions.
• Performs a variety of administrative support activities in support of the unit operations.
• Responds with tact and discretion to the needs of patients and families.
• Maintains privacy and confidentiality by abiding by HIPAA policies.
• Independently creates staffing assignments, scheduling, and delegation of tasks or work assignments.
• Independently provides training and quality assurance to new and current staff members.
• Independently identifies trends in process opportunities and provides educational training to team members for improvement.
• As a first line representative of CT Children's, this person must have the ability to deal compassionately and professionally with patients and families.
• Performs Quality Assurance (QA) & Training: Audits Complete Registration data including documentation records regarding incomplete information at time of scheduling/registration/account follow-up, patient or guarantor interaction, efforts to collect co-payments, estimated self-pay balances, and referrals to Medicaid.
• Ensures all outstanding issues are resolved in a timely manner.
• Identifies trends and conducts follow-up training to reduce number and frequency of outstanding issues.
• Provides weekly review for new employees; at minimum monthly review for current employees.
• Ensures employees drawers are closed in a timely fashion, per standard process.
• Creates/maintains spreadsheets and databases.
• Acts a liaison with patient accounting department for denials and account problem resolution.

Registration:

• Collects and enters accurate demographic, guarantor and financial data for Emergency Department, Inpatient and Outpatient cases and Physician Practice Office appointments.
• Verifies all required insurance and billing information and uses the proper payer plan codes.
• Generates all necessary forms for patient visit and obtains patient/parent/legal guardian signature for Assignment/Authorization and consent.
• Performs pre-registration for scheduled patients and registers patients adhering to standard department procedure.
• Makes corrections and updates patient information in ADT systems as necessary.
• Asks patients/families whether their visit was satisfactory and attempts to address any questions/issues prior to patient departure.
• Attempts to collect the patient liability, co-payment on all accounts at the designated collection point. Documents thorough, clear, explanatory notes regarding reasons for incomplete information at time of registration and documents insurance verification method along with response. Documents concise and understandable comments regarding patient or guarantor interaction, efforts to collect co-payments and referrals to Financial Counseling.
• Follows-up on open items to resolve outstanding issues and complete the file.
• Reviews and works assigned work queues for registration information to ensure that accounts are accurate at time of visit and or billing.
• Creates feedback loop to front-end user in regard to correct and complete registration.

Scheduling:

• Schedules routine and complex appointments either in person or via telephone.
• Creates/inputs routine and complex department provider appointments.
• May schedule/coordinate appointments with other areas of the hospital.
• Builds and maintains scheduling templates.
• Ensure all consent and privacy forms are signed.
• Work directly with DCF to obtain appropriate signatures/legal guardian information.

Front Office (Check-In):

• Arrives patients for their appointment in the ADT system.
• Verifies demographic and insurance information at time of arrival (including securing patient financial liability at time of service).
• Enters routine to complex patient charges into billing system for physician or care provider visits, according to protocol.
• Independently performs check out process including scheduling or rescheduling future appointments.
• Answer telephone and triage calls for the department.
• Ensure all consent and privacy forms are signed.
• Work directly with DCF to obtain appropriate signatures/legal guardian information.
• Other front office duties as required.

Financial Clearance:

• Responsible for various work queues of scheduled and/or non-scheduled appointments.
• Communicates with insurance companies to obtain benefits, referrals, and/or authorization requirements.
• Communicates with Clinical/Office staff regarding patient eligibility, authorization status, and need for clinical documentation.
• Completes chart reviews to submit all appropriate documentation to insurance companies for authorization purposes.
• Coordinates with third party payers regarding information necessary for appropriate financial processing of patients, including: follow-ups with primary care providers for referrals and authorizations; notifying insurance carriers of admissions; obtaining authorizations and verifying benefits eligibility.
• Refers patients/families to Financial Counseling for updated and/or eligibility issues.
• Works directly with RN, APRN, and MD level staff to notify of denials requiring further action.
• Coordinates with Utilization Review for status designation of Outpatient/Inpatient Admissions.
• Coordinates daily assignments and escalates clinic concerns to management team regarding authorization barriers.
• Works directly with Insurance Provider Representatives, when necessary, in order to have outstanding authorization issues resolved.
• Maintains abnormality tracking of outstanding issues, which cause delay and/or denial of authorization.

Financial Counselor:

• Responsible for various account review work queues.
• Communicates with insurance companies to obtain insurance benefits.
• Communicates with other departments regarding patient eligibility and financial application status.
• Support Financial Counselors with patient's/families' account inquiries.
• Expert in EPIC billing system.
• Interviews patients and/or families, in-person or by phone, to verify complete insurance and financial information, explain financial policies, complete appropriate financial evaluation forms.
• Assists patients/ families with DSS and Financial Assistance process.
• Determines guarantor's propensity to pay non-covered charges, as well as determine potential eligibility for financial assistance programs.
• Establishes financial arrangements / payment plans with patients.
• Identifies reason(s) for non-payment and follows-up to ensure resolution.

Financial Responsibility:

• Verifies insurance plans using the various methods available such as RTE, Web-Based, & Telecommunications.
• Investigates patient insurance coverage, facilitates certification, manages process to maximize payment from both commercial and managed care plans.
• Follows-up with team member responsible for patient account to resolve outstanding financial issues.
• Demonstrates knowledge of the age-related differences and needs of patients in appropriate, specific populations from neonate through adolescence and applies them to practice. Demonstrates cultural sensitivity in all interactions with patients/families. Demonstrates support for the mission, values and goals of the organization through behaviors that are consistent with the CT Children's STANDARDS.

Supervisory Responsibilities:

• May be responsible to coordinate daily activities of the department; delegate assignments to staff; and serve as a primary resource to staff.
• 1st level resource to staff and various leadership regarding daily processes and issues.
• Active participant of minimum 1 hospital committee; shares departmental and/or organizational initiatives with team members.

Qualifications

Education and/or Experience Required:

• High School Diploma, GED, or a higher level of education that would require the completion of high school, is required.
• Healthcare experience required.

Education and/or Experience Preferred:

• Bachelor's or Associate's Degree strongly preferred.
• 2-4 years directly related experience required; 1 year of CT Children's direct related experience preferred.

License and/or Certification Required: