Patient Access Lead

Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Patient Access Lead functions as an integral member of the team and is the first point of contact for all people inquiring about the provider's practice. The primary role is to organize the practice's daily activities and paperwork.

Primary Responsibilities :

• Maintains up-to-date knowledge of specific registration requirements for all areas, including but not limited to : Main Admitting, OP Registration, ED Registration, Maternity and Rehabilitation units
• Ensures complete, accurate and timely entry of demographic information into the ADT system at the time of registration
• Properly identifies the patient to ensure medical record numbers are not duplicated
• Responsible for reviewing assigned accounts to ensure accuracy and required documentation is obtained and complete
• Meet CMS billing requirements for the completion of the MSP, issuance of the Important Message from Medicare, issuance of the Observation Notice, and other requirements, as applicable and documenting completion within the hospital's information system for regulatory compliance and audit purposes
• Collects and enters required data into the ADT system with emphasis on accuracy of demographic and financial information to ensure appropriate reimbursement
• Carefully reviews all information entered in ADT on pre-registered accounts. Verifies all information with patient at time of registration; corrects any errors identified
• Identify all forms requiring patient / guarantor signature and obtain signatures
• Ensures all required documents are scanned into the appropriate system(s)
• Identifies all appropriate printed material hand-outs for the patient and provides them to the patient / guarantor (Patient Rights and Responsibilities, HIPAA Privacy Act notification, Advance Directive, etc.)
• Follows "downtime" procedures by manually entering patient information; identifying patient's MRN in the MPI database, assigning a financial number; and, accurately entering all information when the ADT system is live
• Follows EMTALA-compliant registration steps for both Emergency Department and Labor and Delivery areas
• Assesses self-pay patients for presumptive eligibility and when appropriate, initiates the process
• In the Emergency Department follows protocol for special cases, including but not limited to 5150, Sexual Assault Response Team (SART), Domestic Violence patients, Child Protective Services, incarcerated patients, Worker Compensation patients, auto accidents, animal bite reporting, etc. as required
• Monitors and addresses tasks associated with the Mede / Analytics PAI tool
• Follows approved scripting, verify insurance benefits on all patients registered daily by using electronic verification systems or by contacting payers directly to determine the level of insurance coverage
• Thoroughly and accurately documents verification information in the ADT system, identifying deductibles, copayments, coinsurance and policy limitations
• Obtains referral, authorization and pre-certification information; documents this information in the ADT system and submits notices of admission when necessary
• Verifies medical necessity checks have been completed for outpatient services. If not completed and only when appropriate, uses technology tool to complete medical necessity check and / or notifies patient that an ABN will need to be signed. Identifies payer requirements for medical necessity
• Verifies patient liabilities with payers, calculates patient's payment and requests payment at the time of registration
• Identifies any outstanding balance due to previous visits, notifies patient and requests patient payment
• Sets up payment plans for patients who cannot pay their entire current copayment and / or past balance in one payment
• Thoroughly and accurately documents the conversation with the patient regarding financial liabilities and agreement to pay
• When collecting patient payments, the department policy and procedure follows regarding applying payment to the patient's account and providing a receipt for payment
• Clarifies division of financial responsibility if payment for services is split between a medical group and an insurance company. Ensure this information is clearly documented in the ADT system
• When necessary, escalates accounts to appropriate Patient Registration leadership staff, based on outcomes of the verification process and patient's ability to pay clinic(s)

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include :

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications :

Preferred Qualifications :

Soft Skills :

Physical and Work Environment :

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 to $35.72 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

#RPO #RED