Patient Access Associate

MedStar Franklin Square Medical Center - Baltimore, MD

Job Summary
Obtains accurate demographic and insurance information/authorization from patient/family who are accountable for compliance with Medicare and government mandates to insure financial reimbursement to FSMC. Assigns beds and physicians, PA's, and NP's to elective, direct and emergency admissions insuring appropriate patient care. Cross-trained associates rotate job assignments to include inpatients, private practice outpatients, ambulatory patients, lab registration, receptionist, and bed control duties.
Minimum Qualifications
High school graduation or equivalent; knowledge of ICD-9 and CPT coding; knowledge of third party reimbursement preferred.

2 years related hospital experience with bed assignment responsibility preferred.

No special certification, registration or license required.

Knowledge, Skills & Abilities
Proficient use of hospital registration systems. Accurate typing skills. Outstanding quality and customer service skills. Demonstrated critical thinking in initiating solutions to various problems. Ability to multi-task. Ability to work both independently and as a member of a team. Good verbal and written communication skills.
Primary Duties and Responsibilities
Assigns beds in a timely manner and knows proper priorities. Interacts with all nursing units and ancillary units concerning all bed placements. Communicates census to Supervisor, maintains a close relationship with the Nurse Supervisor during these times. Performs a census reconciliation daily and updates bed board to reflect an accurate picture of in-house patients. Completes doctor card daily, pages and assigns residents and physician's assistants accurately and timely; documents same on doctor card. Follows guidelines for assignment of same. Completes intake form for direct admissions staying in guidelines of established Medical Administrative Action Policy.
Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards and safety standards. Complies with governmental and accreditation regulations.
Greets all patients and family members. Maintains sign-in list for ASC and Admitting with patient name, date of service and time of arrival. If appropriate, re-verifies all data obtained via a pre-registration. Directs or escorts patient to appropriate area in hospital as needed.
Interviews patients, families, or outside sources to obtain complete and accurate demographic and financial information. Secures specific data concerning third party coverage to include name of insurance, address, phone number, policy number, group number, PCP and HMO Center, if applicable. Inputs data into registration system for billing and patient tracking. Selects appropriate codes for insurance and patient type, such as ASC, POP or In-patients. Ensures that all necessary questionnaires and specific forms are completed according to requirements by government or regulatory agencies. Processes high volume of telephone calls in a timely and efficient manner. Takes postings for elective, direct admissions, ASC, AOC, radiology, nuclear medicine, HEC and other ancillary departments with accuracy.
National Medical Review Policy (NMRP) is followed according to Medicare requirements. If a physician has not completed the ABN nor provided an appropriate diagnosis, ICD9 code for specific test, contacts physician for verbal diagnosis. Enters verbiage into registration system and converts to an ICD9 code to complete the ABN. Informs patient if Medicare will not pay for specific test and collects monies as listed in computer system. Documents system appropriately for all aspects of the NMRP process.
Obtains authorizations and benefits by utilizing available resources such as, Blue Line, EVS, HDX and Access Line. Explains financial requirements to patient or responsible party and collects copays or deductible amounts as required. May phone insurance companies and physicians offices for levels of benefit coverage, preauthorization, referrals, care plan, etc. required to provide service and receive payment from third party payors, i.e. secures forms and signatures, verifies forms for completeness. Keeps abreast of changes in insurance policies and billing procedures through newsletters, memos, seminars and special training sessions.
Participates in meetings and on committees and represents the department and hospital in community outreach efforts as required.
Participates in multidisciplinary quality and service improvement teams.
Performs other duties as assigned.
About MedStar Health
MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation and research. Our 30,000 associates and 5,400 affiliated physicians work in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest visiting nurse association in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar is dedicated not only to teaching the next generation of doctors, but also to the continuing education and professional development of our whole team. MedStar Health offers diverse opportunities for career advancement and personal fulfillment.