Patient Access Coordinator IV

Acts as resource person for staff on their shift and insures smooth operation of the area. Obtain and verify appropriate personal, demographic and financial information for the purposes of ensuring (1) Quality patient care through proper patient identification and (2) maximal reimbursement for all billable clinical services rendered. Performs all Department functions as needed. Delegate workflow duties per assignment indicated on Daily Placement.

Responsibilities

Education and Leadership Skills

Provides education and training/mentoring for other staff members. Conducts and attends department meetings and reviews procedural & process changes per facility specific guidelines.

Assist and clear accounts for billing from WQ’s established.

Ensures new associate orientation is completed.

Must present positive role model. Facilitates Performance Improvement processes. Responsible for staffing issues during on call coverage.

Interviews patients and obtains and verifies appropriate personal demographic and financial information for the purposes of ensuring: (1) quality patient care through proper patient identification and (2) maximal reimbursement for all billable clinical services rendered. Assesses and updates information as it relates to each encounter. Determines financial plan and coverage priority.

Analytical Skills

Analyze patient accounts; evaluate financial data for Establishment of current accounts and documents comments to reflect actions taken regarding accounts to maximize reimbursement Prioritize organizations participation in insurance contracts. Maintain knowledge of current HMO/PPO/Medicaid/Medicare/commercial insurance regulations and requirements. Requires working knowledge of Insurance Plans the Christ Hospital participates in. Determines all insurance coverage’s as primary, secondary, tertiary, etc. Completes required MSPQ questionnaires for all appropriate patients. Obtains and documents clinical referrals from other providers. Coordinates Patients in need of financial assistance to pay for present and/or future services to appropriate Financial Counselor. Collects and deposits according to specified protocols, all required and mandatory insurance co-payments.

Initiates on-line verification of third party Insurance Carriers and Plan Administrators to verify patient benefits. Evaluates and prepares chart documentation to establish that Medical Necessity guidelines have been met. Prepares and completes documentation that establishes Medicare Compliance such as Medicare Secondary Payor Questionnaire and Advance Beneficiary Notice. Documents appropriate data in Account Doc and guarantor notes. Prepares daily census statistics, reconciles patient days and patient type changes.

Clinical Skills

Effectively facilitates room assignment for patients admitted for an inpatient, observation, or ambulatory stay who require recovery time utilizing established medical criteria for patient placement. Coordinates all internal and external transfers. Processes Emergency, Obstetrics, newborns and elective admissions as needed.

Answers and directs incoming calls, schedules from physicians, Physician’s office staff, ancillary departments and other facilities. Answers inquiries concerning hospital policies, processes orders for patients placed in bed.

Compliance Skills

Determines organizations participation in insurance contracts. knowledge of current HMO/PPO/Medicaid/Medicare/Commercial Insurance regulations and requirements. Screens and completes all required documentation and prioritizes all insurance coverage’s as primary, secondary, tertiary. Completes required MSPQ questionnaires for all appropriate patients. Obtains and Documents clinical referrals from other providers. Coordinates Patients in need of financial assistance to pay for present and/or future services to appropriate financial counselor. Collects and deposits according to specified protocols, all required and mandatory insurance co-payments. Documents appropriate data in Account Doc and guarantor notes.

Auditing work completed by registration to ensure compliance with Medicare and all third party payor guidelines, inclusive of JCAHO standards.

Obtains signatures for the visit including consent to receive all treatments, medications, test, transfusions, therapy and other procedures. Charts procedures in the respective patient medical record, all collected forms and photocopies (insurance cards) documentation. Distribute, witness by signature and collect patient advanced directive forms/information; referring patients to appropriate personnel to address specific questions as indicated. Provides patients with information about their rights and responsibilities and all other duties as assigned.

Must maintain facility established productivity and quantity standards per Department Quality Guidelines (i.e. 100% accuracy of 95% of all registrations).

Communication/Interpretation Skills

Demonstrates effective verbal and written communication skills.

Must meet guidelines of Customer Service skills.

Must follow appropriate communication guidelines between management and associates. Documentation and follow-up must be timely.

Adheres to confidentiality and HIPAA policies of the organization.

Qualifications

KNOWLEDGE AND SKILLS:

Please describe any specialized knowledge or skills, which are REQUIRED to perform the position duties. Do not personalize the job description, credentials, or knowledge and skills based on the current associate. List any special education required for this position.

EDUCATION: High School Diploma, Associates Degree preferred or equivalent combination education and experience.

YEARS OF EXPERIENCE: One to three years experience in Registration, Billing, Customer Service, or Managed Care Organization work environment. Must have/gain knowledge of the Hospital Medical Staff rules and infection control policies to be effective in this position.

REQUIRED SKILLS AND KNOWLEDGE: Analytical skills required to make decisions based on the facility and clinical situation at hand.

Computer Literacy – use of multiple systems

Epic, Passport, OnBase, Cisco, Microsoft Office products.

Ability to use Internet Access and utilize third party payor systems for eligibility and verification.

Knowledge of health insurance coverage, requirements.

Excellent communication, problem solving skills, and ability to deal with customers who are often adversarial. Ability to be flexible, organized and function well in stressful situations. Ability to interact Independently to resolve Customer Service issues.

Typing (minimum of 35 words per minute or equivalent key strokes).

Must understand medical terminology and be able to determine bed placement based on condition and the contra indication of roommates/isolation needs. Coordinates placements of patients with RN Supervisor based on medical condition.

LICENSES & CERTIFICATIONS:

Annual Registration Competency Review with 95% or greater score obtained.

Yearly STAT testing completed.