Patient Access Representative II

Reporting to the Patient Access Manager, the Patient Access Associate exhibits a high level of customer service while verifying and preparing all patient accounts for inpatient and outpatient billing in order to maximize payment for Hospital and Clinic services. Reviews and verifies all payment methods available (insurance, self-pay, agency), verifies patient/insurance information, works with patients to set up payment arrangements and to arrange/apply for assistance programs, assists in collecting copayments and deductibles, and problem solves basic billing inquiries.

Primary Duties and Responsibilities:
OBTAINS/CONFIRMS AND ENTERS/UPDATES DEMOGRAPHIC AND INSURANCE INFORMATION FOR ALL PATIENTS
•Consistently confirms, enters, and/or updates all required demographic data on patient and guarantor in registration system(s) on a daily basis to achieve maximum payment.
•Secures and/or explains copies of insurance card(s), forms of ID, and signature(s) on all required forms and scans them into the appropriate imaging documentation system.
•Consistently completes the Medicare Secondary Payer (MSP) questionnaire, if applicable.
•Discusses Advanced Directives with patients and obtains a copy for the patient’s record, if available.
•Reviews all other regulatory forms and information with the patient, such as Notice of Privacy Practice and Billing information.
•Verifies insurance using Real Time Eligibility, Payer Website, or phone number to determine coordination of benefits and obtains authorization and/or referrals as required.
•Follows procedures to accurately identify a patient and apply the patient identification bracelet, if applicable.
•Registers patients during downtime following downtime procedures and enters data into registration system immediately upon system availability.
•Performs Service Recovery as needed at the point of service with patients and visitors.

VERIFIES INSURANCE COVERAGE, SCREENS PATIENT FOR POTENTIAL FUNDING SOURCES, AND SETS EXPECTATIONS FOR REIMBURSEMENT OF SERVICES.
•Verifies financial information to determine insurance coordination of benefits, pre-certification/prior-authorization requirements by contacting the insurance company or through other verifying technology.
•Informs self-pay patients of prepayment requirements or screens for funding sources
•Prepares estimate of procedures, calculates advance payment requirements, informs patient of acceptable payment arrangements on previous and current balances
•Refers potentially eligible patients to contract eligibility vendor(s) to pursue funding reimbursement
•Coordinates with clinical areas to establish patient financial expectations and assist in the resolution of revenue cycle issues
•Maintains up to date knowledge, requirements, and skills to perform daily duties and meet key performance metrics for the facility, unit, and payers. For example, employee must read all e-mails/newsletters and attend required training sessions.

COLLECTS, POSTS, AND RECONCILES ALL PAYMENTS FROM PATIENTS
•Consistently collects patient payments and provides receipt accurately completing all required fields.
•Calls patient prior to date of service to inform them of their expected financial liability. Will educate patient on their respective benefits and accept payment over the phone is patient agrees.
•Coordinates with appropriate providers when payment is unable to be collected from the patient. If necessary, secure a waiver for services.
•Accurately posts all payments on system.
•Accurately reconciles receipts with cash collected and completes required balancing forms at the end of their shift.

PERFORMS OTHER POSITION APPROPRIATE DUTIES AS REQUIRED IN A COMPETENT, PROFESSIONAL, AND COURTEOUS MANNER