Patient Access Representative II

Job Summary

Responsible for ensuring that all necessary information is accurately collected and recorded. Will work to provide a positive patient experience while obtaining the information necessary to facilitate patient care and billing processes.

Qualifications

Minimum Requirements :

High school diploma or equivalent required

One (1) to three (3) years administrative and in-person customer service experience required, preferably in a health care setting; patient access services experience preferred.

Familiarity with and understanding of hospital admissions, patient account systems, and major health insurers and general coverage issues preferred

Previous cashiering experience preferred

Demonstrated typing proficiency, personal computer, and CRT experience required; Enterprise Scheduling System experience preferred

Demonstrated interpersonal, oral and written communication skills required

Essential Job Functions :

Interview incoming patients, or their representative, to obtain all pertinent and financial information required for the proper preparation of all forms and records. Obtain required signatures on the financial agreements form.

Perform admitting duties and register patients via hospital computer system. Enter daily orders / charges via the Order Entry System on each outpatient and inpatient as required. Receive orders from patient care units and respond accordingly.

Assign patients to a room based on diagnosis, precautions, and type of accommodations available or requested. Escort or arrange to have patient transported to appropriate room. Transfer and discharge patients as requested by Nursing Service.

Perform scheduling duties. Receive referral information from patients, physicians, and therapists. Schedule patients according to current systems and keep all systems and involved parties up to date throughout each day. Track cancellations and no-shows.

Interact effectively with medical and nursing staff in the Emergency Department in order to gather correct, complete data necessary to ensure that clinical and fiscal responsibilities are facilitated for both the patient and the Hospital. Follow manual procedures when computer system is not functioning properly.

Accept pre-admission orders from physicians either in writing or orally. Schedule pre-admission testing in accordance with Hospital regulations and guidelines.

Schedule all elective admissions. Notify physician's office that an admission type may be inappropriate according to insurance guidelines. Alert the physician's office when prior approval is needed for a patient. Schedule necessary pre-admission appointments and patient assessments.

Call patients at home to verify information prior to admission and call physician's office if a patient has not arrived for his / her pre-admission visit. Visit patient(s) or family on Hospital unit if necessary to complete data.

Stay current with new admission regulations of the many public and private insurance companies which patients carry such as Medicare pre-admission approval guidelines, Master Health Plus prior approval, and others.

Recognize and take action when a patient is scheduled inappropriately or does not follow necessary procedures so as not to leave the Hospital at a financial risk. Contact an insurance plan for authorization, if necessary, prior to admission. Determine which insurance plan is to be billed as primary or secondary.

Explain over the phone and in person, hospital and insurance regulations relating to surgery, visiting hours, charges, pre-admission testing requirements, clinic appointment verification, and other related issues to patients as necessary. Listen to complaints and concerns of patients and the public, assisting to solve problems if possible and escalating to a supervisor when necessary.

Transmit required information to appropriate departments. Use phone system to page physicians and technologists and park calls as needed. Utilize Keyfile system for faxing reports to physician's offices online. Utilize optical imaging system to retrieve radiology reports.

Provide patient information in accordance with regulations governing divulgence of information, such as providing ambulance personnel with necessary information.

Distribute federal and state-mandated information to patients.

Verify benefits on all designated patient types. When necessary, assist with pre-certifications with insurance carriers. Notify patients and / or appropriate medical personnel of outcome.

Notify insurance carriers of admissions, observations, or other patient visits as required.

Receive payments from patients or their representative. Assist patients with short form Free Care applications.

Post and total all Hospital receipts in standard Cash Receipt Journals. Balance cash against receipts. Prepare bank deposits. Maintain petty cash. Act as a custodian of patients' valuables for safekeeping.

Maintain confidentiality of all patients' records and data. Interface with medical records department as required based on department, hospital, and patient care needs.

Maintain census statistics and index of assigned and vacant beds.

Requisition office supplies and forms when necessary.

When triage nurse is not on duty, prioritize the admitting needs of patients. Alert medical personnel of patients needing immediate attention.

Provide coverage for extra shifts in the case of an unexpected absence of a staff member or for vacation coverage to provide coverage for patient care needs. Work a flexible schedule as needed and be able to work in other satellite facilities such as Amherst. Regular and reliable job attendance is an essential job function.

Maintain established hospital and departmental policies and procedures, objectives, confidentiality, quality improvement program, safety, compliance and environmental standards.

Meet annual competency and retraining requirements.

Attend meetings as required.

Perform other functions / duties as requested.