Patient Access Representative

SUMMARY Under the general supervision of the Supervisor, and according to established policies and procedures, interviews and registers all patients (Inpatient and Observation, Emergency, and Outpatients) to obtain demographic, third party insurance and related financial information, and enters to on-line computer system. Initiates, reviews and follows-up on patient accounts to ensure proper data collection for billing. Verifies all demographic and insurance information and obtains referrals as required. Brown University Health employees are expected to successfully role model the organization’s values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include: Instill Trust and Value Differences, Patient and Community Focus and Collaborate. RESPONSIBILITIES Greets and directs all patients, families and visitors in a prompt and courteous manner. Interviews patient or patient’s representative to obtain complete and accurate third party health insurance and related personal/financial information. Follows-up on missing data by interviewing patients, families or calling employers, nursing homes and other facilities. Completes registration and enters all data obtained into hospital computer system. Prepares or completes manual records as required: ensures patient is properly identified in system per department policy, verifies demographic and insurance information by asking open-ended questions, registers all patients (Outpatient, ED, Inpatient and Observation) by entering and/or verifying demographic insurance information into hospital information system, upgrades account to an active account status, completes documentation required on financial clearance reports as indicated by Patient Advocate or Pre-Registration Office. Utilizes online tools and/or telephone to verify coverage, determine level of benefits, and confirm that the primary care physician (PCP) matches the PCP recorded in hospital system. Contacts insurance carrier or company for missing information when necessary, notifies Pre-Registration Office if coverage changes from pre-admit/pre-registration information. Identifies primary and secondary insurer, properly records insurance information in system, completes lien forms upon determination that a liability exists, enters financial notes into system. Gathers paper referrals from patients when required by the payer, updates SMS with the appropriate documentation, contacts Financial Counselor/Pre-Registration Office if the insurance does not verify or if the patient does not have a referral when required by the payer. Utilizes system to determine self-pay balances for all patients, uses reference tools to determine the expected payment due at time of service, contacts Patient Financial Advocate to estimate expected payment on complex cases. Refers patients to Patient Financial Advocates if patients cannot meet the expected payment according to defined criteria, collects co-payments as required per financial clearance or as required by third party payor or department policy, documents collections in system, logs payments, provides receipts per department policy, completes financial clearance screens in system. Explains consent, financial and insurance forms to patients or designee and provides general hospital information regarding policy and procedure, obtains patient signatures on all required forms to meet established hospital requirements (i.e., Privacy notice, Ethics brochures, Patient Rights, Hospital Directory, The Miriam Hospital Welcome Brochures). Generates patient registration record and plate and distributes appropriate copies, verifies and updates all information, makes required plates, bracelets, and face sheets, places bracelet on patients per department policies in accordance with patient identification policy. Utilizes hospital department scheduling and workflow reports to complete daily work, communicates with service departments to obtain order information as required, communicates with Financial Counselor/Pre-Registration Office to obtain authorizations not obtained at or prior to time of service. Asks patient for Advance Directive and includes with admission paperwork to go to nursing unit, provides patients with information on Advance Directives if one is not prepared, explains and has patient sign Advance Beneficiary Notice (ABN) as required, completes medical necessity checks utilizing order entry system per hospital policy if not done during pre-registration process. Distributes Payment Policy brochures when patient lacks evidence of adequate health insurance coverage, according to established criteria, ref... #J-18808-Ljbffr