Non-Clinical - Administrative - Patient Access Representative

TITLE : Patient Registration Representative I Admitting : Unit / Cost Center : 300-8560 FTE (1.0) Temporary position 6 : 00 AM 2 : 30 PM Days : Monday- Friday, 8-hour shifts, no weekends POSITION SUMMARY Enables patients to secure access to care at PIH Health facilities by performing all tasks related to registration and pre-registration of outpatient and inpatient accounts. Calculates and secures patient liability, including copayments, coinsurance and deductibles in an efficient, accurate and hospitable manner to ensure that the patient, physician and hospital s needs are met. SPECIFIC SKILLS NEEDED Must have excellent written and verbal communication skills to communicate effectively with staff, patients, guarantors, insurance companies, and physicians. Demonstrated attention to detail; Good English speaking, spelling, reading and Mathematical skills required Demonstrate ability to learn quickly, and follow directions as outlined in policies or given by Supervisor Strong Computer skills and Knowledge in Word, Excel and ability to maneuver through multiple screens in a timely manner 1+ year of medical office / hospital / medical billing work experience preferred Medical terminology knowledge strongly preferred Insurance knowledge required Ability to multi-task in a fast and high-pressured environment Stringent adherence to all HIPAA laws Strong typing skills 45 and up wpm is required Strong analytical skills, problem solving. The ability to act and decide accordingly. Excellent Customer service and phone skills with a background in the medical industry Ability to travel to off-site locations (Outpatient only) EDUCATION / EXPERIENCE / TRAINING One-year experience in a high-volume healthcare facility or medical office setting with strong computer and customer service experience required High school graduate required or equivalent, evidence of continuing education preferred. Medical terminology strongly preferred Insurance and billing experience strongly required Drivers License; ability to travel to off-site locations (Outpatient only) Bilingual Spanish or Chinese (Mandarin) preferred LA City Fire Card within 6 months of employment (PHGSH only) DUTIES AND RESPONSIBILITIES 1. Safeguards and preserves the confidentiality of patient s protected health information in accordance with State and Federal (HIPAA) regulatory requirements, hospital and departmental policies. 2. Ensures a safe patient environment and adherence to safety practices per policy. 3. With consideration to age, employee utilizes the approved process to resolve biophysical, psychological, educational and environmental needs of patient / significant other as required. 4. Guest Relations : Exhibits positive guest relations skills by extending oneself and being hospitable to patients, physicians, coworkers, and visitors at all times. Warmly greets these by name and introduces self by name. Uses the phrase, "How can I help you?" as a first line of communication. Anticipates concerns and provides an explanation of the interview process. Utilizes translators if available or new translating system Stratus as necessary to ensure patient fully understands the information being discussed with them. Displays a teamwork approach, considering the impact of his / her decisions, actions and behaviors on others. Works with our eligibility vendor to create a positive working relationship that will provide a smooth process for the patient. Responds to others in a constructive, non-defensive manner. Maintains a professional appearance at all times, wearing uniforms or adhering to department dress code requirement, as per policy. Answers telephone by the third ring and states, ______ department, this is ______, and how can I help you? Expresses ideas clearly, actively listens and always follows appropriate channels of communication. Maintains confidentiality at all times. Full disclosure is provided to patient when starting the interview and screening process for Hospital Presumptive Eligibility and / or Uncompensated application, so they understand the process. 5. Organizational skills and Efficiency : Able to solve problems without compromising the patient s needs. Sets priorities, integrates changes and organizes work activities in a logical and timely manner. Demonstrates a consistent level of performance and productivity. Files orders in the correct files and places files in the appropriate file and scan accordingly. Follows all procedures in department as instructed by management. Uses time wisely to pre-register all scheduled patients, as per policy. Prepares necessary paperwork, orders, labels, and forms for signature to expedite the registration process upon the patient s arrival. Makes good use of time, seeks out work that needs to be done (ex. pre-registration), reports free time to supervisor. Responsible for completing all assigned procedures during shift without sacrificing the quality of work. Limits personal phone calls to breaks and lunches : away from the work area. EMERGENCY : Productivity completes a minimum of 20 registrations but strives for up to 30+ registrations per 8 hr shift which includes scanning documents, insurance verification and securing upfront collections. Verifies patients are appropriately medically screened and stabilized before Consent of Admissions is signed / discussed and or liability is requested. No patients are to leave the Emergency Department without registration being completed. When necessary Registration Representative will start the interview and screening process for Hospital Presumptive Eligibility for patients without insurance who present in the Emergency department. Registration Representative will evaluate patients within established guidelines to assist in identifying qualification to the HPE program. Registration Representative will be required to following the M / Cal guidelines and regulatory requirements to secure the most accurate information needed to complete the application process. Registration representative will ensure all insurance, demographic and eligibility information is obtained and entered into the system accurately and appropriate eligibility worker is notified. If patient does not qualify for HPE the clerk will pre-screen for hospital s Uncompensated Care program based on financial income and family size. If patient qualifies for this program, registrar will complete application process with patient, scan accordingly and submit original to the business office for approval process. Registration clerk will document into MS4 the entire process to notify the business office staff of outcome and status for this patient. Timeliness : registers all patients who present in a timely manner. Patients are to have the full registration completed with the COA signature obtained within 30minutes once medically screened by provider. ADMITTING / OUTPATIENT DEPARTMENTS : Productivity : completes a minimum of 20 registrations but strives for up to 30+ registrations per 8 hr. shift or 35 pre-registrations per 8 hr shift. Completes full pre-registrations for scheduled patients within 2 business days of being scheduled or if patient presents in department to pre-register. All scheduled patients are to have the full pre-registration process completed, which includes estimates issued on all accounts along with securing copay / liability over the phone when applicable or no later than the day prior to procedures. Admitting : Responsible for identifying and capturing all Self Pay accounts from emergency department to start the interview and screening process for Hospital Presumptive Eligibility and / or uncompensated care program. Timeliness : registers all patients who present in a timely manner. All patients are to be registered within 15 minutes of arriving for service. If there is a delay past that time frame, management is to be contacted for assistance. Front Desk Clerk / OB / Inpatient Admitting : completes a minimum of 15 registrations but strives for up to 30+ registrations per 8 hr. shift, which includes scanning documents, verifying eligibility, front end collections with required application and accurate order entry. OB Admitting : Will schedule all OB procedures (C-Sections, Pre-op, Inductions, etc.,) in Enterprise scheduling system. 6. Flexibility : Demonstrates ability and willingness to work productively in all registration departments. Exercises independent and efficient judgment in times of need and emergency situations while adhering to departmental and hospital policies. Demonstrates willingness to adjust schedule to meet departmental and census needs (management s discretion). Provides assistance and information to patients, physicians, department members and others, as needed. 7. Complies with all Policies and Procedures, demonstrate accuracy through attention to detail. Minimum standard : 95% of all registrations must be 100% correct to include all data entry, insurance cards photocopied or scanned, all forms signed and complete. To include but not exclusively : Accurately and completely enters patient demographic, employer, relative, medical and insurance information into the computer, as per policies. Downtime registrations are equally complete and accurate upon system being available. Each time a registration is created, the FIND PATIENT page in Access Manager is searched and the correct medical record number is selected or entered. Does not create duplicate MPIs. Utilizes all available tools to accomplish accurate registrations to include policies but not limited to : policies, cheat sheets, emails, procedures outlined, shared drive, Reg Tips and internet. Consistently follows up on incomplete information to ensure complete and accurate registrations prior to billing. COA, Driver License or ID, Insurance Authorization, and other necessary paperwork are to be scanned accordingly. Complies with all consent laws and obtains all required signatures, as required per policy. If patient cannot sign forms, document reason. Follows up on missing signatures and makes every attempt not to leave follow-up for coworkers. Complies with policies regarding PSDA", Important Message From Medicare, "Medicare Patient Rights" and HIPAA laws and documents accordingly. MSP-Medicare Secondary Payer document must be completed when applicable, 100% MSP accuracy required. 8. Collections : Utilizes positive collection skills, as per policy, while complying with EMTALA laws. Ensure Emergency / Maternity / Urgent patients understand that services are provided regardless of ability to pay. Notifies add on patients of their liability in an informative manner as outlined per policy. Request payment from all patients with out-of-pocket, co-pay, and coinsurance. Educates patients about their insurance coverage along with their financial responsibility in a clear and compassionate manner, keeping in mind the mission and values of PIH Health which includes uncompensated care program and Hospital Presumptive Eligibility screening by setting the appropriate format for the financial counselor to speak with them with further education. REGISTRATION Request payment from all patients that have liability in a professional and knowledgeable manner. Ability to properly explain how estimated amount was collected in accordance with PIH Health s collection policies. Demonstrates successful collection skills by collecting payment, setting up payments plans and securing reimbursement for 75% of insured patients with liability and some form of payment for 33% of self pay patients that do not qualify for HPE, Medi-Cal or charity. Utilizes Patient Payment Estimator when applicable. Enters payment and account number accurately in the Payment Navigator system. Has knowledge of PIH Health pricing, cash rates and prompt pay discounts. PRE-REGISTRATIONS prepares completed pre-registration for Financial Counselor and department, if liability can be determined collect payment over the phone upon pre-registration. Take the payment information over the phone and enter in the Payment Navigator system. Immediately notifying Financial Counselor of all Self-Pay accounts or no authorization. 9. Growth : Demonstrates participation in the Performance Improvement program and ability to turn problems into opportunities for improvement. Demonstrates an active interest in improving current level of skill and knowledge by regularly reviewing Policy and Procedure via Intranet, actively participates in bi-monthly staff meeting discussions as well as other hospital required education and intellectually curious and able to see the big picture . Demonstrates willingness and ability to learn new skills and to adapt to change with a positive attitude; and overall commitment to the key values, vision, mission, and goals of the organization. Interest in promoting to Registration Representative II and Financial Counselor. 10. Attendance : Adheres to attendance and tardy policy and provides notification of absence per policy. Maintains a satisfactory attendance record, not limited to tardiness and leaving work early. Takes responsibility for keeping and knowing work schedule. Notifies supervisor far in advance of requests for schedule changes so minimal disruption occurs with current work requirements and or pending projects. PTO requests are made in a timely manner per department requirement (understanding that there is no guarantee PTO will get approved). Reports unscheduled absences to management / department at least 2 hours prior to the beginning of the scheduled work shift per policy. Follows Kronos policy for swiping in / out for all scheduled shifts. Uses Time Correction forms minimally; no more than 7 correction forms in any 4 week period. Time Correction forms are completed and accurate and turned into Supervisor / Manager / Director on the day incident occurred with time clock. 11. Safety : Maintains a clean and safe work environment per policy. Reports all problems immediately. Completes CBT exams and annual health evaluations before annual review. 12. Performs other duties as assigned, with professionalism. TEAMWORK / CUSTOMER SERVICE RESPONSIBILITIES : 1. Customer Service Values and Behaviors : 1.1 Value : Each person is treated with respect, dignity, fairness and compassion. Behavior : Performance is acceptable when everyone is promptly greeted with a smile in a warm and caring manner using the person s name whenever possible. Now matter how I feel, I display a caring attitude. 1.2 Value : Each person displays loyalty and pride in PIH Health and upholds the confidentiality of patients, visitors, physicians, and co-workers. Behavior : Performance is acceptable when concerns / problems with fellow employees and customers are not discussed with anyone other than the person involved or the supervisor. Customer issues and ideas are listened to and appropriate follow up occurs to create a satisfied customer. I do not make excuses. I do not demean other people or departments. 1.3 Value : Each person demonstrates commitment to open communication. Behavior : Performance is acceptable when openness and acceptance of constructive criticism occurs. Positive communication occurs by complimenting and expressing appreciation to others. I will listen and encourage others to express ideas and opinions. 1.4 Value : Each person demonstrates pride in the physical appearance of all PIH Health properties. Behavior : Performance is acceptable when the initiative is taken to maintain a clean and safe environment. I conduct myself in a manner which respects and preserves equipment and the physical plant. I do not walk by spills, trash or unsafe conditions without assuring that they are attended to promptly by me or appropriate personnel. PERSONAL QUALITES : Punctual Effective communication skills, organized, dependable, with a positive professional appearance and attitude. Ability to collect, analyze and research complex or diverse information Strong analytical skills, problem solving. Flexible, adaptable. Attention to detail With consideration to age, employee utilizes the approved process to resolve biophysical, psychological, educational and environmental needs to patient / significant others when administering care. Effective time management skills and sound work ethics. Ability to make good use of time and seek out work that needs to be done. Ability to make good decisions. Ability to keep confidential information. Professional appearance (complies with official dress code) and attitude.