Patient Access Representative - Full-Time - AVALA Hospital - RH385

Patient Access Representative

Under the supervision of the Business Office Manager, the Patient Access Representative is responsible for obtaining accurate patient demographics and insurance information during the patient interview process; the process includes in-person, and phone interviews, corrects information as needed. Processes the registration including obtaining the patients signature on the Authorization for Treatment, Advanced Beneficiary Notice (ABN) and completing the Medicare Secondary Payer (MSP) questionnaire. Scans all necessary documentation into Patient Account. Performs verification of benefits and fully understands plan benefits. Collects co-payments, estimated co-insurance and deductibles, which includes phone calls to physician offices to discuss financial authorization status prior to service as well as collecting at time of service. Answers incoming phone calls and assist caller as needed. And any other duties assigned by the Business Office Manager.

Essential Duties and Responsibilities

Registration and Verification

• Able to handle heavy phone volumes, ensures that callers are transferred to the appropriate department and/or person. Answers calls in a timely manner; identifies department and self when answering the telephone. Able to handle all codes and stat calls proficiently.
• Verifies that patient demographic information is accurate and ensures that insurance cards, consents and other admission documents are complete and in order.
• Ability to explain required forms to the patient in detail (i.e.: Authorization for Treatment, Advanced Beneficiary Notice (ABN), and Medicare Secondary Payer (MSP) questionnaire). Obtains required signatures as needed.
• As part of the pre-registration process, contacts patient to verify demographic information, insurance information, and MSP questionnaire.
• Ability to verify insurance coverage and understand benefit requirements and ensures that all notification/authorizations are completed based on plan requirements.
• (a) Work with physician offices to obtain necessary authorization on scheduled procedures.
• Ability to explain insurance benefits to patient.
• Informs patients of estimated balance due based on plan benefits and collects monies due at time of service.
• Demonstrates knowledge of all features and functions of the Patient Accounting areas.
• Notifies appropriate staff regarding any issues or concerns in a timely manner.
• Balances daily receipts list to cash, checks, and credit card payments received at the end of each day.
• Communicates with management/physician offices regarding any problematic insurance concerns that may affect the payment of services.

Other Duties

• Functions as back up to concierge.
• Other duties as assigned.

Core Competencies

• Action Orientation - Targets and achieves results, overcomes obstacles, accepts responsibility, establishes standards and responsibilities, creates a results-oriented environment, and follows through on actions.
• Communications - Communicates well both verbally and in writing. Effectively conveys and shares information and ideas with others. Listens carefully and understands various viewpoints. Presents ideas clearly and concisely and understands relevant detail in presented information.
• Creativity/Innovation - Generates novel ideas and develops or improves existing and new systems that challenge the status quo, takes risks, and encourages innovation.
• Critical Judgment - Possesses the ability to define issues and focus on achieving workable solutions. Consistently does the right thing by performing with reliability.
• Customer Orientation - Listens to customers, builds customer confidence, increases customer satisfaction, ensures commitments are met, sets appropriate customer expectations, and responds to customer needs.
• Interpersonal Skills - Effectively and productively engages with others and establishes trust, credibility, and confidence with others.
• Leadership - Motivates, empowers, inspires, collaborates with, and encourages others. Builds consensus when appropriate. Focuses team members on common goals.
• Teamwork - Knows when and how to attract, develop, reward, and utilize teams to optimize results. Acts to build trust, inspire enthusiasm, encourage others, and help resolve conflicts and develop consensus in creating high-performance teams.

Professional Requirements

• Meets dress code standards and adheres to policies.
• Completes annual education requirements.
• Maintains regulatory requirements.
• Maintains patient confidentiality at all times.
• Reports to work on time and as scheduled, completes work within designated time.
• Wears identification while on duty, uses computerized punch time system correctly.
• Completes in-services and returns in a timely fashion.
• Attends annual review and department in-services, as scheduled.
• Attends staff meetings or reads and returns all monthly staff meeting minutes.
• Represents the organization in a positive and professional manner.
• Actively participates in performance improvement and continuous quality improvement (CQI) activities.
• Complies with all organizational policies regarding ethical business practices.
• Communicates the mission, ethics and goals of the hospital, as well as the focus statement of the department.
• Assists other staff members in performing any duty that enhances the delivery of patient care.

Regulatory Requirements

• High school diploma.
• Two (2) or more years' experience.

Skills

• Ability to communicate effectively in English, both verbally and in writing.
• Basic computer knowledge.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. This position is very active and requires repetitive motions, standing, walking, bending, kneeling and stooping all day. The employee must frequently lift or move items weighing up to 20 pounds.