Patient Access Representative

Overview

The Patient Access department is staffed 24 hours a day with personnel directly responsible for pre-registration insurance verification, scheduling, and registration of all inpatients and outpatient into the organization. Arranges for the efficient and orderly admission of inpatients and registration of individuals who have hospital-based outpatient testing or procedures. Ensures that the patient information is collected and that patients are aware of their rights to make decisions regarding their healthcare, conditions of admission, patient rights and financial responsibilities, hospital policies and procedures. Answers and directs calls to appropriate areas, follows hospital protocol regarding emergency codes and overhead announcements. Interviews incoming patient or patient representatives and enters information required for registration into computer database. Distributes appropriate information to ancillary departments. Participates in department meetings, hospital and department in services, performance improvement and CQI activities. Adheres to infection control policies and guidelines appropriate for their work area. Hand hygiene and PPE (job applicable) followed when appropriate.

Responsibilities

• Coordinates and processes referral requests, guiding the patient and the referring provider’s office through the intake and scheduling process. This ensures that their needs and expectations are met in a timely manner while providing exceptional customer service.

• Receives referrals via multiple delivery methods, including email, fax, telephone, and EMR interface.

• Schedules patient appointments, including diagnostic tests, procedures, surgeries, physician consultations, post-op/follow-ups, and other ancillary tests.

• Responsible for pre-registering patient appointments by calling insurance companies or using payer portals to obtain and document eligibility and benefits, coverage assignments, and patient financial responsibility.

• Calls patients before appointments and educates them on out-of-pocket expectations.

• Provides procedure estimates and attempts to collect prepayments and outstanding past-due balances.

• Screens patients for the ARH Financial Assistance Program or determines eligibility for referral to other funding resources.

• Performs all tasks to support and obtain pre-authorization from insurance companies, including:

• Submitting pre-certification requests and clinical documentation via online portals, phone, and fax with correct CPT and ICD coding.

• Researching payer medical policy requirements and treatment authorization guidelines.

• Following up on outstanding authorization requests and medical documentation requests promptly.

• Communicating with medical/clinical staff and patients regarding authorization status and outcomes.

• Communicating with ordering providers regarding denied or disputed determinations.

• Contacts patients and physician offices for additional information and follow-up.

• Responsible for clearing assigned task lists and workloads within EMR systems daily while maintaining quality and productivity standards to ensure the highest level of service and optimal patient care.

• Adheres to all department and organization policies and procedures and state and federal laws and requirements.

• Performs other duties as assigned.

Qualifications

Minimum Education:  High School diploma or equivalent required. Associate’s degree preferred.

Minimum Work Experience:

• High School Diploma or Equivalency required.
• Two years experience in healthcare registration preferred
• Excellent verbal, presentation and written communication skills.

 Required to comply with OSHA regulations for the N95 respirator training and fit testing. (job classifications that require fit testing)

Required Skills, Knowledge, and Abilities:

• Ability to communicate in English, both orally and written.
• Ability to work independently within general guidelines.
• Ability to work well with others in a calm, friendly manner in a high volume, high stress environment.
• Ability to remain focused amid frequent interruptions.