Pillar Health, A Division of KCHC, is looking for a Patient Access Representative III to join its team.
POSITION SUMMARY
The Patient Access Representative III (PAR III) is to provide exceptional patient care by creating a patient service experience that is phenomenal for each and every patient who visits. PAR III works as a partner in the clinic together with the practitioners, assistive clinical staff, other administrative staff, and leadership to provide a welcoming, caring and healing environment for patients. Where this position deals directly with patients and family members, PAR III is responsible for ensuring that patients' needs are listened to, understood, and resolved within the scope of this job description. PAR III is primarily responsible for the full insurance authorization process and explanation of the patient's fiscal responsibility relative to treatments, procedures and/or medications requiring insurance authorizations.
PRIMARY FUNCTIONS
The list of duties and responsibilities is not all inclusive and may be expanded to include other duties and responsibilities, as management may deem necessary from time to time.
CORPORATE VALUES
- Maintain patient confidentiality and functions within the guidelines of HIPAA.
- Ability to function well while involved in multiple tasks and assignments.
- Ability to concentrate on details while experiencing frequent interruptions.
- Review all company messaging systems at the beginning and end of every shift.
- Welcome and orient new patients to the facility.
- Connect patients to wrap-around services, including, but not limited to; Aging and Disability Resource Center (ADRC), Badger Care, Wisconsin Well Woman Program (WWWP), medication assistance.
- Coordinate patient transportation assistance.
- Interact with all patients in a professional and courteous manner.
- Ability to direct all incoming calls to appropriate staff.
- Other duties as assigned.
REGISTRATION
- Verify and update patient demographic information.
- Verify and update patient insurance information and select appropriate guarantor per service line during check-in process.
- Initiate new patient full registration process.
- Record patient demographics in EHR to satisfy Universal Data Set (UDS) requirements.
- Coordinate handoff to Intake Registered Nurse.
SCHEDULING
- Ability to appropriately take accurate detailed messages and send them to the appropriate person via the Electronic Health Record (EHR).
- Identify triage situations in patients through red flag words and terminology during patient interaction.
- Work collaboratively with nursing staff to schedule urgent visits.
- Schedule and reschedule patient appointments according to the scheduling guidelines.
- Ensure confirmation of all scheduled appointments via Care Messaging platform, MyChart or directly with patient.
- Verify changes to insurance benefits prior to scheduling or during the confirmation process.
- Ability to understand and implement schedule templates.
- Review the Reschedule list in the EHR and schedule appointments appropriately.
- Review the Follow-Up list in the EHR and schedule appointments appropriately.
- Review the Waitlist in the EHR and schedule appointments appropriately.
- Communicate with care team regarding same day appointments or changes in scheduling.
CHECK IN/CHECK OUT
- Inform patients of balances they owe in a professional and courteous manner.
- Collect payment for services provided.
- Inform patients and obtain acknowledgement of consent for treatment, clinic and appointment policy adherence, patient and payment responsibilities.
- Collect and/or verify photo identification of patient and guardian (where applicable).
- Check in patients via the EHR for scheduled services or walk-ins.
- Collect payment at time of service, including copays and/or outstanding balances according to payment policy.
- Review patient paperwork for accuracy and follow up with patient for missing information.
- Scan completed paperwork to patient chart in EHR.
- Print and reconcile end of day batch report with on hand cash, attest to reconciled batch report then deposit in drop box.
- Ensure patients have documented guardian or case worker present when appropriate.
INSURANCE ENROLLMENT (PAR II/III)
- Understand insurance rules and regulations, especially those related to insurance authorization.
- Communicate with revenue cycle vendor regarding patient billing concerns.
- Review and approve patient payment plan request and receive first payment; document payment plan in EHR.
- Inform patient of expectation to notify insurance carrier of Primary Care Provider (PCP).
- Record patient household composition and income in EHR.
- Meet with and assist patients in completing all required paperwork and documents for insurance enrollment (i.e. Medicaid/Marketplace) when appropriate.
- Identify, review and assess Sliding Scale Fee options with patients.
PRIOR AUTHORIZATION (PAR III)
- Review treatment plan report daily and identify services requiring Insurance Authorizations.
- Submit and monitor Insurance Authorization requests to insurance carriers; complete necessary documentation as required.
- Review Insurance Authorization denials with providers for modifications and/or resubmission.
- Contact patients regarding Insurance Authorization denials and discuss other payment options.
- Communicate with team members regarding Insurance Authorization approvals for appointment scheduling.
- Ensure payment requirements are met and the care team is notified of patient payment compliance.
- Receive and distribute dental lab cases upon receipt of insurance approval and/or payment responsibility.
POSITION REQUIREMENTS
Education and/or Experience
High School Diploma/GED required. Six to twelve months related experience preferred. Customer Service experience in a clinical setting preferred. Ability to use computer software such as WORD and EXCEL to perform tasks. Prior experience with using an Electronic Health Record preferred. Annual Maintenance of Certified Assistance Counselor (CAC) Certification required.
Language Skills
Ability to read and comprehend instructions from your manager. Ability to effectively communicate with patients and employees from the organization. Ability to communicate in Spanish (oral and written) preferred.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the primary functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the primary functions. While performing the duties of this job, the employee is frequently required to stand; walk; sit; use hands to finger, handle, or feel; and talk or hear. Sitting greater than 75% of the time. Walking and standing less than 25% of the time. The employee is occasionally required to reach with hands and arms and stoop, kneel, crouch, or crawl. The employee must occasionally bend and lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, and ability to adjust focus.
This position requires compliance with the Health Center’s written standards, including its Employee Handbook, Compliance Program and Standards of Conduct and policies and procedures (“Written Standards”). Such compliance will be an element considered as part of the regular performance evaluation.
The above statements reflect the general details necessary to describe the principal functions of the occupation described and shall not be construed as a detailed description of all the work requirements that may be inherent in the occupation.
I have read the above job description and agree to perform the duties and responsibilities as described above. I understand that this job description is intended to describe the general nature and level of work performed. It is not intended to serve as an exhaustive list of all duties, skills and responsibilities that may be required of me as a Patient Access Representative III.
WORK SCHEDULE
Open availability to work between 32-40 hours during clinic operating hours. Clinics generally operate Monday – Thursday, 7 am – 7 pm, Friday, 7 am – 5 pm, and Saturday, 7 am – 3 pm.
WHAT WE OFFER
As a full-time employee, you will receive an impressive portfolio of benefits designed to help you maintain a comfortable lifestyle for you and your qualifying dependents, including Major Medical, Dental, Vision, Flexible Spending Account, Short-term Disability, Long-term Disability, Life Insurance, Employee Assistant Program, 403(b)
Paid Time Off, including Holidays. Qualifying employer for Public Service Loan Forgiveness (PSLF).
Annual salary to commensurate with experience.
Learn more about us at www.pillarhealthcare.org.
