Patient Access Representative

Summary: Under 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 into 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. In addition, they demonstrate core Success Factors:

• Instill Trust and Value Differences
• Patient and Community Focus
• 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 contacting employers, nursing homes and other facilities. Complete registration and enter all data obtained into hospital computer system. Ensure patient is properly identified in 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 to an active status. Complete documentation required on financial clearance reports as indicated. Utilize online tools and/or telephone to verify coverage, determine level of benefits, and confirm that the primary care physician matches the PCP recorded in the hospital system. Contact insurance carrier or company for missing information when necessary; notify Pre‑Registration Office if coverage changes from pre‑admit information. Identify primary and secondary insurer and record insurance information in the system. Complete lien forms upon determination that a liability exists and enter financial notes into the system. Gather paper referrals from patients when required by the payer; update with appropriate documentation. Contact 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. Utilize system to determine self‑pay balances for all patients. Use reference tools to determine the expected payment due at time of service; contact Patient Financial Advocate to estimate expected payment on complex cases; refer patients to Patient Financial Advocates if they cannot meet the expected payment according to defined criteria. Collect co‑payments as required by financial clearance or third‑party payor or department policy (cash, check, credit card for ambulatory and Emergency services or as indicated by Patient Advocates). Document collections in system, log payments, provide receipts per department policy and complete financial clearance screens. Explain consent, financial and insurance forms to patients or designee and provide general hospital information regarding policy and procedure; obtain patient signatures on required forms, e.g., Privacy Notice, Patient Agreement, Important Message from Medicare/Tricare, Medicare Observation Notice. Verify and update all information; make bracelets and place on patients per department policies. Utilize department scheduling and workflow reports to complete daily work; communicate with service departments to obtain order information as required. Communicate with Financial Counselor/Pre‑Registration Office to obtain authorizations not obtained prior to time of service. Ask patient for Advance Directive and include with admission paperwork to go to nursing unit; provide patients with information on Advance Directives if none prepared. Explain and have patient sign Advance Beneficiary Notice (ABN) as required. Complete medical necessity checks utilizing order entry system per hospital policy if not done during pre‑registration process. Distribute financial aid applications when patient lacks evidence of adequate health insurance coverage, according to established criteria; refer patients to Patient Financial Advocate to assist with applications for medical coverage and to establish payment plans. May pre‑admit/pre‑register scheduled outpatients and inpatients in hospital system. Contact patients to verify demographics at time of scheduling to complete missing info. Verify patient insurance coverage(s), both primary and secondary, online or by telephone. Obtain and verify all other information required to secure payment through sources such as Worker’s Compensation, MSP, Medicare liability, liens, etc. Ensure referrals are obtained and confirm accuracy of the PCP. Establish level of insurance benefits and expected payment for selected services; determine the patient’s portion of payment when applicable and arrange for payment prior to service provision. Check outstanding balances incurred for previous services prior to contacting patient and follow collection policy concerning prepayment. When appropriate, perform medical necessity verifications for services; address ABN’s for payment at the time of pre‑registration. Collect prepayments by phone or mail if time permits before admission or outpatient service; otherwise instruct patient to bring payment at admission. Refer insured patients who cannot meet financial obligations to Patient Financial Advocates per department policy. Update status of financial clearance activities in system. Prepare necessary paperwork prior to patient arrival. Review/correct third‑party payer eligibility reports. Complete real‑time status transfers. At arrival or admission, complete any missing documentation and paperwork required from patients and/or family members. Coordinate with Nursing Department to assign patient beds per case‑management guidelines. Review newly assigned medical record numbers for duplication; report duplicates on appropriate form. Attend and participate in staff meetings. Provide coverage to multiple locations (hospital‑based admitting, ED, outpatient and pre‑reg areas) as needed. Protect and preserve patient privacy and confidentiality. Utilize department equipment such as fax machine, phone, visa machine, laptop PC and other technology. 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. 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 at a workstation requiring continuous use of a computer and telephone. May involve 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: 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: Newport Hospital - 11 Friendship Street, Newport, Rhode Island 02840 Work Type: 3p-7pm every other weekend and holidays Work Shift: Day Daily Hours: 4 hours Driving Required: No #J-18808-Ljbffr Lifespan