Patient Access Rep

Job Title: Patient Services Associate
Location: 40 Duke Medicine Circle Durham, NC 27710, Clinic 1F
Schedule: M-F 8AM-4:30P
Contract: 13 Weeks

Required Qualifications
Education:
High School Diploma (minimum), college preferred
Experience:
- Minimum of 2-3 years experience
• Strong verbal and written communication skills mandatory.
• Basic PC skills.
• Minimum six months data entry experience.
• Medical terminology knowledge
• Knowledge and understanding of telephone etiquette.
• Ability to organize and prioritize.
• Ability to provide oral and written instructions.
• Ability to interact tactfully and courteously with the public.
• Ability to apply specific departmental policies, rules and regulations relating to verifying patient information, collecting payments, and maintaining records and forms.
• Ability to establish and maintain effective relationships with other personnel.

Key Responsibilities:
The Patient Service Associate is an integral part of the patient care team in the clinic /service area. The Patient Service Associate is responsible for patient registration activities including patient identification, documentation of any special needs (language, mobility or other ADA identified needs), demographic and insurance updates. The PSA must ensure all financial and compliance related documents are completed and documented, check-in, check-out, point of service collections (deductible, copay, coinsurance, and balances), referral and order management, appointment coordination/scheduling, work queue management, MyChart enrollment and cash management according to established policies and procedures. The Patient Service Associate is expected to follow all regulatory and compliance policies. The Patient Service Associate is also responsible for living values and demonstrating expected behaviors while contributing to creating a positive patient experience and building a positive work environment. The Patient Service Associate will maintain a professional image in appearance and over the phone. The Patient Service Associate contributes to ensuring the registration desk and waiting areas Client patient privacy, confidentiality and safety and are well maintained and clean.

Patient Registration / Check-in / Check-out
1.Correctly identify patient by checking an approved photo ID and utilizing a minimum of 2 approved patient identifiers. Follow Red Flag procedure for patients unable to identify / verify.
2.Verify, capture, and update demographic information to include name, address, phone number, emergency contact, guarantor, race, ethnicity, veteran status, employer, primary care provider and / or referring provider, primary language and religious preference in Maestro Care as needed. Ensure all information is complete.
3.Verify, capture / update insurance information; determine and select insurance carrier, enter subscriber information, and plan information. Run RTE (Real Time Eligibility) for any updates or changes to insurance and verify benefits for reimbursement.
4.Review / resolve eligibility edits, coordination of benefits, data mismatch, and content errors. Appropriately document in medical record.
5.Capture and appropriately document patients with special needs, for example risk for falls, interpreter, short of stature. Communicate with clinical staff and correctly align special needs fields with any ambulatory documentation conflicts to minimize risks and meet joint commission standards.
6.Present and educate patients on financial, compliance, and authorization forms and obtain all necessary signatures as required per policy. (For example, COA/COT, MSPQ, ABN, and Self-Administered Drugs.) Appropriately label, scan, and document to medical record for retention. Modify communication to ensure patient understanding if necessary.
7.Identify and collect patient financial liabilities (copay, coinsurance, deductibles, account balance); post appropriately based on payment type, payment amount and method of payment.
8.Explain Financial Assistance policy to patients. Complete Medicaid screening questions for self-pay patients. Direct patients to Financial Care Counselor or Customer Service as needed for further financial counseling, billing questions, payment plan set up, missing authorizations for services while protecting the patient's privacy.
9.Explain billing and insurance implications for provider and hospital-based clinics to include the patient's responsibility of co-insurance and co-pay, and the potential for multiple bills. Address all questions and concerns; appropriately refer to FCC or Customer Service if PSA is unable to answer the questions.
10.Provide education, generate enrollment codes and support to encourage MyChart enrollment. Identify and assign appropriate proxy process in accordance with state and federal regulations to minimize inappropriate medical record access.
11.Identify need for clinical questionnaire completion and provide to patients as needed.
12.Communicate wait times; set patient and provider expectations; round in waiting room to ensure a positive patient experience. Address concerns with patient; involve clinic leadership as needed.
13.Coordinate prisoner arrival through communication with prisoner's guard and clinical staff to expedite check-in and rooming of patient to ensure patient safety.
14.During checkout process, correctly identify patient; review After Visit Summary (AVS) for patient follow ups. Schedule return appointments; manage referrals and orders.
15.Balance cash, check, and credit card collections at the end of each day; reconcile discrepancies and prepare personal deposit for cash manager according to cash management policies.
16.Meet Private Card Industry (PCI) standards by securing cash and credit card receipts at all times during clinic hours, following policy for obtaining and return of cash bags on daily basis.
17.Obtain Imprest cash bag at the beginning of the shift. Complete Imprest cash bag logs, void refund logs, and receipt book logs (as needed) to meet internal control standards.
18.Resolve system-warning messages related to registration items (for example verification of patient coverage, review of guarantor information for billing / collections, and confirmation check list items) to ensure compliance with billing and safety regulations.
19.Completes all work according to procedures and standards. Achieve registration quality expectations to meet key performance indicators related to timely billing, collections, patient experience and safety initiatives.
20.Client sensitive information to maintain confidentiality and in adherence to HIPAA guidelines

Scheduling
21.Follow Financial Pathway guidelines when scheduling (Out of network, self-pay, Out of County self-pay and Medicaid) ensuring patient education for financial responsibility and payment expectations.
22.Schedule and coordinate new, return, lab, and study appointments per scheduling guidelines, utilizing questionnaires as appropriate. Ensure appointments are scheduled with correct providers, services, and in the proper order to respect referring provider and patient preferences to achieve efficiency during the patient visit.
23.Correctly link the study orders or referral with the appropriate study, encounter, or appointment.
24.Provide patient with appropriate pre-visit instructions as defined by clinical staff. In addition to pre-visit instructions, provide any necessary locations, times, provider, practice information, and financial responsibility for next appointment.
25.Complete referrals (referral status and scheduling status) to ensure patient safety by scheduling all patient appointments.
26.Achieve scheduling quality expectations to meet key performance indicators to maximize reimbursement, minimize denials and promote a positive patient experience.

Work Queue Management
27.Prioritize and complete work residing in claim edit, patient, referral, and order work queues based on criteria set by leadership to maximize clinic patient flow.
28.Monitor Orders and referral work queues to make sure all tests and studies are scheduled for the patient and linked if necessary. Orders and referrals not completed can result in patient safety issues and negatively impact the patient and provider experience.
29.Resolve registration (100 and 150 level) billing claim edits related to both the technical (HB) and professional (PB) clinic work queues.

Miscellaneous / Patient Engagement and Work Culture
30.Actively participate / engage in clinic process improvement initiatives to maximize workflow efficiency and the patient experience.
31.Achieve or exceed patient experience expectations by remaining helpful, professional and responsive to the patients needs. Consistently use "Words that Work" and "Relate" in daily interactions.
32.Make internal and external customer(s) and their needs a primary focus in one's actions at all times; develop and sustain productive customer relationships.
33.Integrate compassion and concern into daily work activities to deliver the best patient experience and support a teamwork environment for staff.
34.Always present oneself in a way that is consistent with values and behaviors. Treat others fairly and with respect while protecting the dignity, integrity, and rights of each person.
35.Using the approved service recovery guidelines while maintaining composure, determine the best course of action related to patient or clinic concerns and escalate as appropriate.
36.Inform clinical staff of late arrivals and identify appropriate action (for example arrive and reschedule if necessary.) Perform service recovery to mitigate impact to patient experience.
37.Provide directions, arrange for patient transport, and interpreters as necessary.
38.Comply with all regulatory and compliance policies and procedures, understand and follow Joint Commission guidelines.
39.Manage and follow through / take action, as appropriate, to all in basket messages.
40.Use available communication tools to communicate effectively with patients, visitors, and staff.
41.Follow clinic-scanning protocol- appropriately label, scan outside documents/medical records into medical record.
42.Actively engage in the work culture initiatives of the clinic. Be respectful and considerate of others' point of view and embrace the diverse backgrounds of all within the organization.
43.Assists and supports fellow employees in their work to commit to overall organization success.
44.Accept accountability and ownership for all actions and behaviors that affect personal and organizational performance. Demonstrate a climate of trust by acknowledging own mistakes and taking responsibility for one's action.
45.Answer incoming calls. Identify and address caller needs, or transfer to the appropriate area that will meet the needs of the caller.
46.Maintain printers, copiers, and workstations.
47.Attend staff meetings and participate in all required education sessions.
48.Participate in all system, regulatory and policy training. Comply with all regulatory and compliance policies and procedures, understand, and follow Joint Commission guidelines.
49.Ensure a safe environment for patients and staff; report personal and patient safety concerns to clinic leadership within 24 hours of occurrence.
50.Support and adhere to all policies and procedures related technology implementation within the clinic/service areas as applicable (i.e. eCheck In. etc.)