Status: Full Time
Shift: Working hours varies depending on location and shift.
Exempt: No
Summary:
To provide excellent customer service during the patient access/intake process according to established hospital procedures. The Patient Access Associate executes patient access through the continuum of the revenue cycle that supports patient safety, efficiency, cost reduction and service improvement. Patient Access includes, but is not limited to the patient’s pre-encounter, encounter and post-encounter which include accurate and efficient patient registration, insurance verification, scheduling, and pre-service collections in compliance with payer and facility rules and regulations.
Other information:
Other Information
Experience, Knowledge and Skills:
Experience in healthcare admissions, registration, or billing preferred.
Medical Terminology desired
Ability to communicate professionally and clearly over the telephone.
Excellent customer service skills.
Ability to demonstrate conflict de-escalation.
Must be able to interpret complex documents related to insurance benefits.
Must be able to read and understand required components of physician’s orders.
Requires judgement to accurately establish patient identity, assign insurance information according to payer and facility guidelines, associate orders with scheduled services, and transcribe physician orders.
Ability to handle stressful situations. Ability to establish and maintain effective working relationships with patients, employees and the public.
1.Previous Experience:
One (1) year of previous experience in healthcare field or customer service required. Bachelor’s degree can be substituted for one year of experience.
2. Specialized or Technical Education Required:
High school diploma or equivalent. Ability to read, understand and follow oral and written instructions.
3. Manual or Physical Skill Required:
Requires manual dexterity sufficient to operate keyboard, telephone, copiers, and such other office equipment as is necessary. Vision must be sufficient to read computer screens and printed documents, and hearing must be in the normal range for telephone contact. It is necessary to view and type on computer screens for long periods. Work may also require sitting for long periods of time as well as stooping, bending and stretching for files, supplies, or other materials. Must be able to occasionally push a patient/visitor in a wheelchair when needed.
4.Physical Effort Required:
Strength: Light
Push: Occasionally
Pull: Occasionally
Carry: Occasionally
Lift: Occasionally
Sit: Frequently
Stand: Occasionally
Walk: Frequently
Responsibilities:
Responsibilities
1. The Patient Access Associate ensures timely and safe access to medical care by completing patient scheduling, insurance verification and registration processes in an efficient, accurate and timely manner and according to the department guidelines.
2. The Patient Access Associate supports the Patient Access Department role in the revenue cycle by scheduling according to patient/provider’s request, reviewing insurance documents, verifying coverage, updating all insurance information in the patient’s registration, estimating financial responsibility and collecting payments according to the Patient Access and facility guidelines, policies and procedures.
3. The Patient Access Associate is responsible for communicating the purpose of required documents and secures patient’s signatures as required by department procedures.
4. The Patient Access Associate contacts patients, insurance companies, and provider’s offices by phone or through EMR communication applications using excellent customer service for reasons including but not limited to demographic and insurance information in order to support timely and accurate billing of all payers. Performs insurance verification and authorization/pre-certification processes including but not limited to, careful review of the Real Time Eligibility system, as well as clear communication with insurance company representatives for all patients according to the Patient Access Department guidelines.
5. The Patient Access Associate demonstrates basic knowledge of payer types including, but not limited to, Commercial, Medicare, Medicare MCO, Medicaid, Medicaid MCO, Other Governmental, Managed Care, Worker’s Compensation and Self Pay in order to schedule, verify coverage, secure authorization, provide payer notification, and register patients according to the department procedures and payer requirements.
6. The Patient Access Associate demonstrates verbal understanding of terminology as it relates to insurance guidelines, including but not limited to Co-payment, Co-Insurance, Deductible, Maximum Out of Pocket, Allowable/Allowed amount, Payable Rates, Payer Notification, Pre-Certification, Prior Authorization, Guarantor, Primary/Secondary/Tertiary Coverage, Coordination of Benefits and Explanation of Benefits.
7. The Patient Access Associate documents in appointment and/or account notes as well as any appropriate comment fields as instructed in relation to scheduling, insurance verification, authorization or registration of the patient.
8. The Patient Access Associate interacts with relevant departments including but not limited to Ancillary Departments, Revenue Integrity, Financial Services, Information Technology, Health Information Management to solve problems and coordinate any concerns related to patient identification, registration, scheduling, insurance verification or billing issues.
9. The Patient Access Associate assists in patient conflict resolution to ensure timely access to care, as well as to facilitate a positive patient experience.
10. The Patient Access Associate is responsible daily for working assigned work queues to resolve account errors and claim edits timely and accurately to support the facility’s financial goals.
11. The Patient Access Associate complies with all Patient Access Department and facility safety, environmental and infection control policies and procedures, as well as the facility objectives and quality assurance programs.
12. The Patient Access Associate follows the North Oaks Health System’s Compliance Program and Federal and State Regulatory Guidelines.
13. The Patient Access Associate expedites patient flow throughout the patient encounter and works with all staff to ensure patients are seen and discharged in a timely manner and following guidelines.
14. The Patient Access Associate is responsible for scanning patients’ insurance cards and driver’s licenses/form of identification, faxed benefits, any paperwork/forms to support the encounter, such as but not limited to, authorization/referral form, workman’s compensation paperwork, coordination of benefits form into the EMR.
15. The Patient Access Associate is responsible for pre-registering patients with preferred language and scheduling interpreters according to department guidelines. The Patient Access Associate is responsible for working the interpreter report as assigned.
16. The Patient Access Associate are responsible for maintaining their website accuracy and keeping up with their individual passwords.
17. The Patient Access Associate maintains the appearance of the waiting/lobby area. Calling housekeeping when necessary.
18. The Patient Access Associate discusses problems and/or confidential information only in an appropriate setting and only with appropriate personnel.
19. The Patient Access Associate responds to inquiries from patients, relatives, physicians, insurance companies and the public quickly and efficiently by actively listening and taking appropriate action.
20. The Patient Access Associate performs appropriately in difficult situations by remaining calm, professional and notifying appropriate personnel and initiating appropriate action.
21. The Patient Access Associate keeps any confidential documents secure and out of public view.
22. The Patient Access Associate maintains par level of supplies and communicates to his/her Leader/designee when supplies are needed.
23. The Patient Access Associate ensures equipment is functional and ready for service, including paper levels in copiers, printers and fax machines.
24. The Patient Access Associate establishes effective relationships with co-workers in their own department, as well as other departments.
25. The Patient Access Associate assists others and shows willingness to work as a team player.
26. The Patient Access Associate is responsible for working referrals as assigned.
27. The Patient Access Associate is to review, verify, and update the patient’s primary care provider at each visit.
28. The Patient Access Associate is responsible for pulling and preparing patient charts prior to appointment, as well as identifying any missing items needed for scanning or updating them in record.
29. The Patient Access Associate, being part of the revenue cycle team, will assist on working denials when needed.
30. The Patient Access Associate is responsible for reconciling all daily encounters, deposit details and any other necessary paperwork to comply with the facility deposit procedures.
31. The Patient Access Associate recognizes diagnosis and CPT codes as necessary to complete scheduling, registration, insurance verification, authorization, notification, price estimates and order transcription as assigned.
32. When required by role assignment, the Patient Access Associate ensures Emergency Medical Treatment and Labor Act (EMTALA) compliance, by registering patients according to department/hospital guidelines.
33. When identified, the Patient Access Associate removes and labels broken equipment or furniture from patient and visitor areas and notifies a supervisor.
34. Patient Access Associate calls for all other service repairs as need is identified.
35. The Patient Access Associate assists patients and visitors in way- finding.
36. The Patient Access Associate is responsible for the complete and accurate entry of all Patient Information into the EMR including but not limited to:
a. Patient Demographics
b. Advanced Directives
c. MSPQ Data
d. Payment Information/Collections
e. Deposits/Deposit Validation
f. Preferred Language/Interpreter Needs
g. Release of Information
h. Patient Rights and Responsibilities
i. Conditions of Treatments
j. Financial Disclosure
k. Mail/Package Receipt and Delivery
l. Coordination of Benefits
m. Preference of Communication
n. Current Payer information
o. Authorization Notification
p. Provider Network Status Notification
q. Advanced Beneficiary Notification
33. The Patient Access Associate communicates regularly with patients in the waiting area and ensures that the patients are fully informed of delays. They will escalate and facilitate resolutions when delays become significant.
34. The Patient Access Associate is responsible for always maintaining a professional demeanor and confidentiality with patients, care givers, visitors, physicians and co-workers.
35. The Patient Access Associate enhances professional growth by participating in education programs, attending staff meetings and participating in committees as required.
36. The Patient Access Associate will assist with review, monitoring and working the no show, wait list, and cancelation report as assigned and identify opportunities for continuous quality improvements. The Patient Access Associate is responsible for following up with patient to reschedule from these reports.
