Patient Access Representative I

The Hospital Authority of Miller County•Colquitt, GA

About The Position

JOB SUMMARY: The Patient Access Services Representative Patient Access Specialist I is an entry-level position focused on learning and mastering the fundamental aspects of patient registration and customer service. The specialist will work under close supervision while gaining confidence and accuracy in registration processes. performs all outpatient and inpatient registration functions including hospital cashiering and insurance verification. Ensures that patients meet financial requirements. Provides general information to hospital users, patients, and families. Communicates effectively to service delivery areas to maximize patient flow and customer service. Provides excellent patient focused customer service. Auditing and Quality Review In addition to core registration responsibilities, the Patient Access Representative will perform regular audits and quality checks to ensure accuracy, compliance, and optimal patient experience. The following auditing duties are included in this role: Auditing Responsibilities: Insurance and Verification and Accuracy: Review and verify insurance information for all Inpatient and Swing Bed admissions to ensure accurate and up-to-date coverage is documented. Required Documentation Compliance: Confirm that all required patient forms, including but not limited to the MOON (Medicare Outpatient Observation Notice) form, have been properly signed by the patient and their guarantor. Primary Care Provider Accuracy: Audit patient records to ensure that the Primary Care Physician (PCP) listed is accurate and updated in the system. Medicare and Medicaid Eligibility Checks For all patients listed with Medicare or Medicaid, verify eligibility and confirm there are no active Medicare Advantage or Medicaid CMO (Care Management Organization) plans that would alter billing or coverage Portal Consent for Underage Patients Audit portal consents for patients under age 18 to ensure proper authorization and that access limitations for minors are observed in accordance with privacy regulations. Portal Enrollment Confirmation Review patient portal consent forms to ensure patients who opted to sign up were successfully sent an invitation and access link. Investigate and resolve any issues preventing access.

Requirements

High School graduate or equivalent
Previous experience with health insurance and patient billing required.
Completion of medical terminology course required.
Complete a 30-day and 60 Day Competency Check List to become Certified as an Advanced beginner.
Ability to communicate in English, both verbally and in writing.
Basic Computer Skills
Have near normal hearing: Hear alarms/telephone/normal speaking voice.
Have near normal vision: Clarity of vision (both near and far), ability to distinguish colors.
Have good manual dexterity.
Have good eye-hand foot coordination.
Ability to perform repetitive tasks/motion.
Continuously within shift (67-100%): Standing, Walking.
Frequently within shift (34-66%): Bending/Stooping, Pushing/Pulling, Lift/carry up to 20lbs, Lift/carry greater than 20 lbs. with assistance.
Occasionally within shift (1-33%): Sitting, Climbing, Twist at waist, Lift/Carry greater than 50 lbs. with assistance, Reaching above shoulder.

Nice To Haves

Previous medical office experience preferred.
Additional languages preferred.

Responsibilities

Responsible for obtaining necessary demographic and financial data through patient interviews, the centralized scheduling system and system queries to complete the pre-registration process.
Assures all check-in procedures are completed, and monitors patient wait times, communicating changes to the patient, as necessary.
Reads and interprets insurance responses.
Communicates financial obligations to patients and collects fees at time of service as appropriate.
Accurately performs medical record maintenance and releases.
Performs cash posting following department guidelines.
Abides by organizational and HIPAA guidelines, privacy practices, patient confidentiality and patient rights.
Must maintain high regard for confidentiality.
Notifies patient or guarantor of anticipated financial responsibility including copays, deductibles, or coinsurances and collects accordingly.
Performs cash posting following department guidelines.
Communicates the purpose of and completes all necessary regulatory forms with patience.
Completes patient's visit by scheduling any necessary follow-up appointments to include any specialty or ancillary services as possible.
Documents financial arrangements.
Assist with departmental workflow as needed.
Communicates with Physician Offices, Staff, and other departments.
Familiar with Advance Beneficiary Notice, Medicare Secondary Questionnaire, Medicare Outpatient Observation Notice, Important Message from Medicare, precertification, ICD-10 coding, Medical Terminology.
Identifies patients who require early financial counseling intervention.
Maintains knowledge of departmental applications i.e., CERNER, Relias, Heartland, Hometown Health, GAMMIS, Availity, my ABILITY, and other systems utilized by Patient Access Services.
Multiple tasks and responsibilities. I must pay attention to detail.
Ability to perform efficiently and effectively under stress.
Adherent to Strict EMTALA guidelines in financial data collection and collection of co-pays are followed.
Strong teamwork between the clinical staff and the financial staff is required.
Strong teamwork, communication and customer service skills are required.
Manages a high volume of incoming calls.
Responds to questions and concerns and directs them to an appropriate location or department.
Responsible for reviewing hospital outpatient service orders for accuracy and medical necessity when required.
Performs all other duties and projects assigned.
Presents consent forms and notifications to patients and obtains all necessary patient signatures and information at time of arrival.
May initiate and perform administrative duties to ensure efficient daily business operations, including participating in the office/department opening and closing procedures, assisting with maintaining, ordering, and restocking front office supplies, and receiving and distributing mail.
Assist Supervisor and/or Manager with development of staff by being available to teammates, acting as a resource to help complete complicated/complex tasks, providing on the job training to team, and seeking out opportunities to become actively involved in staff workflow and development.
Insurance and Verification and Accuracy: Review and verify insurance information for all Inpatient and Swing Bed admissions to ensure accurate and up-to-date coverage is documented.
Required Documentation Compliance: Confirm that all required patient forms, including but not limited to the MOON (Medicare Outpatient Observation Notice) form, have been properly signed by the patient and their guarantor.
Primary Care Provider Accuracy: Audit patient records to ensure that the Primary Care Physician (PCP) listed is accurate and updated in the system.
Medicare and Medicaid Eligibility Checks For all patients listed with Medicare or Medicaid, verify eligibility and confirm there are no active Medicare Advantage or Medicaid CMO (Care Management Organization) plans that would alter billing or coverage
Portal Consent for Underage Patients Audit portal consents for patients under age 18 to ensure proper authorization and that access limitations for minors are observed in accordance with privacy regulations.
Portal Enrollment Confirmation Review patient portal consent forms to ensure patients who opted to sign up were successfully sent an invitation and access link. Investigate and resolve any issues preventing access.