Patient Access Representative I

Patient Access Representative I

Reporting to the Patient Access supervisor, the Patient Access Associate exhibits a high level of customer service while verifying and preparing all patient accounts for inpatient and outpatient billing in order to maximize payment for Hospital and Clinic services. Reviews and verifies all payment methods available (insurance, self-pay, agency), verifies patient/insurance information, works with patients to set up payment arrangements and to arrange/apply for assistance programs, assists in collecting copayments and deductibles, and problem solves basic billing inquiries.

Primary duties and responsibilities include:

• Obtains/confirms and enters/updates demographic and insurance information for all patients.
• Secures and/or explains copies of insurance card(s), forms of ID, and signature(s) on all required forms and scans them into the appropriate imaging documentation system.
• Consistently completes the Medicare Secondary Payer (MSP) questionnaire, if applicable.
• Discusses Advanced Directives with patients and obtains a copy for the patient's record, if available.
• Reviews all other regulatory forms and information with the patient, such as Notice of Privacy Practice and Billing information.
• Verifies insurance using Real Time Eligibility, Payer Website, or phone number to determine coordination of benefits and obtains authorization and/or referrals as required.
• Follows procedures to accurately identify a patient and apply the patient identification bracelet, if applicable.
• Registers patients during downtime following downtime procedures and enters data into registration system immediately upon system availability.
• Performs Service Recovery as needed at the point of service with patients and visitors.

Verifies insurance coverage, screens patients for potential funding sources, and sets expectations for reimbursement of services.

• Verifies financial information to determine insurance coordination of benefits, pre-certification/prior-authorization requirements by contacting the insurance company or through other verifying technology.
• Informs self-pay patients of prepayment requirements or screens for funding sources
• Prepares estimate of procedures, calculates advance payment requirements, informs patient of acceptable payment arrangements on previous and current balances
• Refers potentially eligible patients to contract eligibility vendor(s) to pursue funding reimbursement
• Coordinates with clinical areas to establish patient financial expectations and assist in the resolution of revenue cycle issues
• Maintains up to date knowledge, requirements, and skills to perform daily duties and meet key performance metrics for the facility, unit, and payers. For example, employee must read all e-mails/newsletters and attend required training sessions.

Collects, posts, and reconciles all payments from patients.

• Consistently collects patient payments and provides receipt accurately completing all required fields.
• Calls patient prior to date of service to inform them of their expected financial liability. Will educate patient on their respective benefits and accept payment over the phone is patient agrees.
• Coordinates with appropriate providers when payment is unable to be collected from the patient. If necessary, secure a waiver for services.
• Accurately posts all payments on system.
• Accurately reconciles receipts with cash collected and completes required balancing forms at the end of their shift.
• Performs other position-appropriate duties as required in a competent, professional, and courteous manner.

Physical requirements include:

• Ability to perform job functions while standing. (Frequent)
• Ability to perform job functions while sitting. (Frequent)
• Ability to perform job functions while walking. (Frequent)
• Ability to climb stairs. (Infrequent)
• Ability to work indoors. (Continuous)
• Ability to work from elevated areas. (Frequent)
• Ability to work in confined/cramped spaces. (Infrequent)
• Ability to perform job functions from kneeling positions. (Infrequent)
• Ability to bend at the waist. (Frequent)
• Ability to squat and perform job functions. (Infrequent)
• Ability to perform repetitive motions with hands/wrists/elbows and shoulders. (Frequent)
• Ability to reach in all directions. (Frequent)
• Possess good finger dexterity. (Continuous)
• Ability to fully use both legs. (Continuous)
• Ability to fully use both hands/arms. (Continuous)
• Ability to lift and carry 15 lbs. unassisted. (Infrequent)
• Ability to lift/lower objects 15 lbs. from/to floor from/to 36 inches unassisted. (Infrequent)
• Ability to lift from 36 inches to overhead 15 lbs. (Infrequent)
• Ability to maintain 20/40 vision, corrected, in one eye or with both eyes. (Continuous)
• Ability to see and recognize objects close at hand or at a distance. (Continuous) Ability to match or discriminate between colors. (Continuous) (Selected Positions)
• Ability to determine distance/relationship between objects; depth perception. (Continuous)
• Ability to maintain hearing acuity, with correction. (Continuous)
• Ability to perform gross motor functions with frequent fine motor movements. (Continuous)
• Ability to work in a latex safe environment. (Continuous)
• *Ability to maintain tactile sensory functions. (Frequent) *(Selected Positions) *Ability to maintain good olfactory sensory function. (Frequent) *(Selected Positions)
• *Ability to be qualified physically for respirator use, initially and as required. (Continuous) (Selected Positions)

Knowledge, skills, and abilities include:

• Excellent customer service skills are required
• Ability to receive and express detailed information through oral and written communications.
• Uses proper negotiation techniques to professionally collect money owed by our Patients/Guarantors
• Knowledge of insurance plans and benefits
• Computer literate and able to operate in multiple applications such as Microsoft Office
• Minimum typing skills of 35-40 wpm (certified typing test results required)
• Requires eye-hand coordination and manual dexterity
• Requires the use of office equipment, such as computer terminals, telephone, and copiers
• Knowledge of medical terminology.
• Able to handle multiple tasks simultaneously.
• Ability to work weekends, Friday, Saturday, and Sunday. Must be flexible and able to work flex and staggered shifts
• Requires substantial amount of walking

Education requirements include:

• Associate Degree or High School Diploma with 2 years of customer service experience
• Patient Access Certification (preferred)
• One (1) year relevant experience in a medical office or hospital preferred.

Additional job description includes:

• High school diploma or equivalent (GED), with 1 year of customer service experience. Ability to interpret and apply financial procedures and regulations preferred. Previous experience with hospital information systems or word processing preferred.
• If you like working with energetic enthusiastic individuals, you will enjoy your career with us!
• The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.
• Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: