Patient Access Representative I

Job Type


Full-time

Description

Full-Time

Monday-Friday

8am-5pm

JOB SUMMARY:

The Patient Access Services Representative Patient Access Specialist I is an entry-level position focused on learning and

mastering the fundamental aspects of patient registration and customer service. The specialist will work under close

supervision while gaining confidence and accuracy in registration processes. Performs all outpatient


registration functions and performs insurance verification. Ensures that patients meet financial

requirements. Provides general information to office/clinic 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:

• High School Graduate or equivalent.
• Previous experience in medical office setting preferred.
• Experience with billing and insurance preferred.
• Complete a 30-day and 60 Day Competency CheckList to become Certified as an Advanced beginner.

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).


• Attends staff meetings and completes mandatory in-services and requirements and competency evaluations on time.


• Wears protective clothing and equipment as appropriate.


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 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 patience.
• Completes patient's visit by scheduling any necessary follow-up appointments to include any specialty or ancillary services as possible.
• 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. Must pay attention to detail. Ability to perform efficiently and effectively under stress.
• Presents consent forms and notifications to patients and obtains all necessary patient signatures and information at time of arrival
• Verifies patient's insurance eligibility utilizing assigned tools, updates information in patient's account as needed.
• 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.
• Answers the phone in a professional and courteous manner; takes messages; directs calls to appropriate staff members.
• Scans copies of photo ID and insurance verification each visit.
• Collects payments, balances petty cash
• Calls for transportation for patient, etc.

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 and 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 have been properly signed by the patient and 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 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.
• Maintains patient confidentiality at all times.
• Reports to work on time and as scheduled; completes work within designated time.
• Wears identification when on duty; uses 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; leaves 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