Patient Access Representative - Registration (Days)

Patient Access Services Representative

Facilitates quality and efficient patient intake process through pre-registration, registration, insurance, precertification verification, document completion, POS collections, and work output review. Work assignment will include multiple locations within the facility or system, performing various tasks within PAS operations, including call center, patient facing, and bedside functionality.

Education:

High School Diploma or GED

Qualifications:

* Excellent public relations skills. Pleasant professional demeanor when dealing with the public even irate or abusive individuals. Must possess the ability to communicate effectively and maintain good relations with co-workers, the hospital, and medical staff as well as with patients, families, and third party payers.

* Ability to make independent decisions, display emotional maturity, and use sound judgment.

* One year of previous customer Service experience is preferred. Previous experience or knowledge of ICD-9 and CPT-4 coding techniques is preferred. Knowledge of medical terminology is preferred. Relevant training or education may be considered as experience.

* Ability to interact and work well as a part of a team oriented environment.

* Ability to comprehend and apply a large variety of operating procedures.

* Ability to organize for maximum time utilization, productivity, and smooth patient flow.

* Ability to work effectively in high stress situations. Ability to work in a fast-paced environment with frequent interruptions.

* Proficient use of computer equipment.

* Ability to read and write legibly with spelling accuracy.

* Exhibit flexibility through availability to work hours and days, potentially outside of normal ".shifts". or routines, as needed, based on departmental or system demands.

* Some college coursework preferred

Statement Of Employment Philosophy

Being a part of Tanner Health System is more than a job, it is a promise we make to treat every patient with exceptional service every time they walk through our doors. Service excellence is the foundation of our organizational culture and the expectations we all set for each other, our patients, physicians and our community. All employees agree to abide by a set of service standards. These standards are the promise we make to provide the best care possible, and represent our beliefs, values and who we strive to become. We each commit to making Tanner Health System a great place for our employees to work, for patients to receive care and for physicians to practice medicine.

Functions

Area of Responsibilities

* Registration Quality - Registers patients following department's standards, policies and procedures, focused on consistently efficient throughput and the overall patient experience

* Registration Quality - Enters required patient data in the system, with emphasis on accuracy of demographic data and financial information, thus ensuring appropriate revenue classification, routing & reimbursement. Reviews all quality edits, exceptions or rejections via registration quality or billing software to reduce or address denials.

* Verification Quality - Validates all insurance through the appropriate eligibility system and ensures COB (Coordination of Benefits) validation via the payor response or Medicare Secondary Payor Questionnaire (MSPQ) where applicable. Ensures managed care payors are entered correctly in the HIS, per the eligibility response.

* Verification Quality - Reviews data entry to ensure all payor mnemonics utilized, match electronic or phone eligibility obtained to include COB, managed care, coverage types (HMO, PPO, POS, CMO, IP Only, liability etc).

* Verification Quality - Ensures that all pre-certifications authorizations, matching planned services, are completed or updated, within the specified time frames as mandated by the payor's payment authorization protocols and thoroughly documented on the account. Performs medical necessity check, utilizing accurate payor guidelines and facilitates additional diagnosis order requests where relevant.

* Verification Quality -If in a supporting role (ie IP verification, Surgical Verification etc), validates existing payor data from prior registration or pre-registration entry and makes updates revisions appropriately in the account, to ensure a clean claim

* Documentation Quality - Ensures all registration related signature capture is completed to include consents, regulatory documents, etc.

* Documentation Quality - Ensures all relevant payment liability forms are completed consistently & compliantly, to include Medicare Advanced Beneficiary Notices, Medicaid Advanced Beneficiary Notices, Waiver of Liability forms etc. Further ensures these forms are delivered before services are rendered, with focus on the patient experience.

* Documentation Quality -Enters data & comments in the designated HIS fields, to permit timely and accurate follow up, ensuring documentation of financial activity, clearance, special circumstances etc.

* Documentation Quality - Timely and accurately scans all necessary insurance information including insurance cards, personal ID, driver's license, eligibility & authorization validation, etc. Assist with timely order inventory processing by consistently indexing orders from order management system.

* Patient Estimation & Collection - Creates patient estimates based on scheduled or walk in services, using Epic Estimates workflow. Reviews populated data for errors related to location pricing info, coupled with the eligibility responses ie missing benefit info. Reviews developed estimates with patients, to ensure understanding and captures e-signature.

* Patient Estimation and Collection - Always requests payment of patient liabilities based on estimate or eligibility response, utilizing departmental standard scripting, to overcome patient payment obstacles. Applies discounts according to department standard.

* Performs the cashier function for all patients registered and for those that present for account payment of services, when a centralized cashier is unavailable. Completes individual or departmental deposits as directed.

* Productivity - Consistently focuses on maximizing resources and time, to ensure expeditious patient throughput and account processing. Proactively solicits peers and leaders, offering assistance to avoid non-productive or downtime periods.

* Productivity - Remains flexible to provide float support for all PAS operational areas as requested by leadership, through schedule changes and assignments.

* Assist patients with medical records requests where assigned by leader

* Partners with case management and or nursing services to ensure accurate patient placement and status, aligned with physician order.

* Process Improvement - Exhibits a culture of operational excellence through personal ownership in individual and departmental process efficiency, quality and outcomes.

* Maintains a working knowledge of department and facility policies and procedures. Displays independent reasoning skills for problem resolution as required within the scope of job assignments.

* Demonstrates a positive attitude toward all THS customers and projects a positive professional image.

* Maintains proficiency of technical skills in all areas of your primary assigned department as necessary to assume duties of call rotation as required.

* Maintains confidentiality of all patient data and medical information. This includes refraining from accessing your own personal medical record or the medical record of another individual, where you were not actively working the encounter for scheduling, registration, authorization etc. Any instance of this is considered a HIPAA violation.

* Distinguishes and responds correctly to certain disaster or emergency situations such as fire alarm, visitor injury, etc.

* Performs other tasks as assigned.

Compliance Statement

* Employee performs within the prescribed limits of Tanner Health System's Ethics and Compliance program. Is responsible to detect, observe, and report compliance variances to their immediate supervisor, the Compliance Officer, or the Hotline.

Required Knowledge & Skills

Education: High School Diploma or GED

Experience: No prior work experience required

Licenses and Certifications

* NONE REQUIRED

Supervision

* None

Qualifications

* Excellent public relations skills. Pleasant professional demeanor when dealing with the public even irate or abusive individuals. Must possess the ability to communicate effectively and maintain good relations with co-workers, the hospital and medical staff as well as with patients, families, and third party payers.

* Ability to make independent decisions, displaying emotional maturity and using sound judgment.

* One year previous customer Service experience preferred. Previous experience or knowledge of ICD-9, CPT-4 coding techniques preferred. Knowledge of medical terminology preferred. Relevant training or education may be considered as experience.

* Ability to interact and work well as a part of a team oriented environment.

* Ability to comprehend and apply a large variety of operating procedures.

* Ability to organize for maximum time utilization, productivity and smooth patient flow.

* Ability to work effectively in high stress situations. Ability to work in fast-paced environment with frequent interruptions.

* Proficient use of computer equipment.

* Ability to read and write legibly with spelling accuracy.

* Exhibit flexibility through availability to work hours and days, potentially outside of normal ".shifts". or routines, as needed, based on departmental or system demands.

* Some college coursework preferred

Definitions