Patient Service Representative - Pulmonary

GENERAL SUMMARY:


Reporting to the Manager of Access Services interacts with patients and/or their representatives to perform patient access registration and pre-registration intake and/or direct scheduling which may be performed outside of a call center environment. May perform advanced registration functions, status changes and ADT action for bedded patients. Provides billing estimates and point of service collections and assists in ensuring claim accuracy and reimbursement. Functions at the Point of Service (POS) front desks, walk-in registration areas, or emergency room and Immediate Care Center settings. Screens physician's orders and pre-registration data for changes and compliance with payer requirements for medical necessity and pre-certification. Reviews and completes changes to third party eligibility and benefits verification. Enters and/or updates all required data in multiple hospital computer systems to activate accounts and notify clinical department of patient arrival.


I. REPRESENTATIVE FUNCTIONS:


Performs complete and accurate registration and/or admission functions across multiple access services areas or sites to provide information to maximize reimbursement, and ensures timely and thorough information to all other providers and users of patient data. Verifies insurance requirements, obtains and understands insurance benefits. Collects non-covered fees. Registers and pre-registers outpatients in more than one clinical and diagnostic location within their primary area of responsibility and multiple access areas outside hiring location. Access areas include but may not be limited to Busse Center, Emergency/Admitting Department, Immediate Care Centers, Laboratory and Cancer Services.

Interacts with patients and their representatives to collect and interpret all required demographic, insurance, financial, and clinical data necessary to facilitate patient check in and registration at point of service. Offers and/or schedules interpreter services for patients when necessary. Obtains and scans general consent for treatment, identification and insurance cards, Coordination of Benefits and other appropriate documents. Obtain and submit National Provider Identification (NPI) for providers not on staff ordering outpatient diagnostic tests. Interpret physician orders for completeness and compliance with regulatory agencies and NCH policies. Informs patients of registration processes and privacy notification, establishes financial responsibility to meet internal, regulatory or payer requirements. When applicable, completes the Medicare Secondary Payer (MSP) questionnaire and discusses potential deferral of services according to NCH policy. Initiates the Medicare Advance Beneficiary Notice (ABN), as appropriate, and explains payer policies to patients. Streamlines check in process for patient previously pre registered and appropriately updates the account for changes identified upon arrival. Reviews physician's orders for compliance with the Illinois Department of Public Health (IDPH), and the Center for Medicare & Medicaid Services (CMS) regulations and NCH and medical staff office policies.


Ensures financial protocols and requirements are met. Refers patients to Financial Counselors for identification of financial assistance options. Identify clinical and financial criteria that require involvement of Case Management team or Financial Counseling. Collaborate with internal and external customers to provide timely resolution to third party payer requirements prior to date of service. Minimizes third party payer denials by verifying authorization of service prior to forwarding patients to service delivery areas. Maintains current knowledge of insurance requirements communicated by email, memorandum, educational matrices and in-services. Provides support to primary care practices and specialty care providers regarding utilization, authorization and referral activities. Communicates effectively with service delivery areas when unresolved financial issues impact appointment schedules.


Proficient in the use of CPT and ICD codes, and utilizes online payer resources. Utilize estimator to determine financial responsibility and attempt to secure all financial responsibility prior to the date of service. Meet monthly cash collection goals as determined collaboratively by Department Director/Manager. Maintain registration accuracy by meeting or exceeding expectations with 97% or higher accuracy score. Resolve all work queues within Department standards determined time period to release bill holds to ensure timely reimbursement. Log cash collected receipts and maintain balanced cash at all times.

Coordinates scheduling of service areas for patients requiring multiple tests. Identify and assign electronic educational programs for scheduled services. Explains patient prep and way finding instructions to patient. Collaborates with physician offices to check-in appointments and schedule tests post-physician office visits at offsite NCH locations. Electronically records all required and updated information on patient accounts in multiple hospital information systems according to Emergency Medical Treatment and Active Labor Act (EMTALA), the Health Insurance Portability and Accountability Act (HIPAA), payer, and other applicable regulations and standards.


Prepares all required patient registration forms, documents, charts and reports, labels, patient plates, identification bands, medical records forms, and other related documents for distribution to appropriate departments, physicians and clinical staff. Notifies clinical department of patient's arrival.


May do basic precepting for new hires and acts as a resource team member for performance improvement activities and a super user for various registration and scheduling related systems.

May perform as a patient receptionist/greeter. Assists patients with way finding and transport needs. Contacts clinical departments and scheduling staff as needed to assist in promoting the efficient flow of patients and prioritization of service scheduling and admissions. Assists with other tasks to support the clinical department as determined by the Manager of Patient Access.

Performs customer service standards by adhering to the AIDET principles. Investigate and direct patient inquiries or complaints to appropriate medical staff members and follow up to ensure satisfactory resolution. Consistently demonstrate premier customer service and communication skills with all internal and external customers/contacts and ensure the patient and their family members have the best hospital encounter possible.

Adheres to all Northwest Community Hospital standards, policies, and procedures and reports compliance concerns to management staff.

III. SPECIAL SKILLS AND ABILITIES REQUIRED:


Ability to functionally navigate multiple computer software systems with accurate keyboard skills following computer security protocols.

The interpersonal communication skills necessary to interview and interact with customers and physicians and to project a professional and compassionate concierge style of service to patients, patient families, physician's and staff in person and on the telephone.

Ability to work independently, exercising good judgment, and multi-task in a high stress, fast paced service environment with patients, patient's family and physician's.


Detail oriented with good analytical problem-solving skills to appropriately register patients and schedule patient procedures.

Ability to operate routine office equipment (facsimile, copiers, plate production, scanners, printers).

Ability to transact payments at time of service and maintain a cash drawer.

IV. KNOWLEDGE, PRACTICAL EXPERIENCE AND LICENSURE/REGISTRATION REQUIRED:

High school diploma required. College degree preferred.

Minimum 2 years of customer service work experience required.

Minimum of 1 year experience in a healthcare patient access department or hospital required.


Computer experience in a windows environment required.


Previous healthcare experience with regulatory compliance requirements, payer requirements, HIPAA privacy and security requirements, and general revenue cycle procedures required.

Successful on-the-job completion of NCH Patient Access Specialist I competencies required.


Epic Registration and/or Scheduling experience preferred

What you will need: Benefits:

• Career Pathways to Promote Professional Growth and Development
• Various Medical, Dental, and Vision options, including Domestic Partner Coverage
• Tuition Reimbursement
• Free Parking at designated locations
• Wellness Program Savings Plan
• Health Savings Account Options
• Retirement Options with Company Match
• Paid Time Off and Holiday Pay
• Community Involvement Opportunities