Patient Access Representative II

Department:
Patient Registration

Schedule/Status:
Varies; Full Time

Standard Hours/Week:
40

General Description:
This position reports to the Patient Access Manager/Supervisor. The Patient Access Representative is responsible for promoting and demonstrating Parrish Healthcare’s Culture of Choice®; timely and accurate processes associated with pre-registration, insurance verification, pre-certification, and insurance notification.

Key Responsibilities:

• Assist Lead with QA process for all new hires
• Services as a "Shadow Guide" for new hires and a resource for on the job training
• Always follow AIDET (Acknowledge, Introduce, Duration, Explanation, Thank You) guidelines in all interactions with the patient.
• Always maintain professional image and demonstrate excellent customer service.
• Always use two patient identifiers (patient full name and date of birth) for accurate patient identification.
• Perform pre-registration and insurance verification within 3-5 days prior to date of service for both inpatient and outpatient services. For notification received with less than 3 days’ advanced notice perform within 24 hours of notification.
• Meet/exceed performance expectations; completes work within the required time frame. (10 registrations per hour).
• Follow scripted benefits verification and pre-certification format in Health Information System (i.e. Meditech) custom benefits screen and record benefits and pre-certification information in the approved standard format.
• Assign Insurance Plans (IPlan’s) accurately.
• Perform electronic insurance eligibility confirmation and document results.
• Complete Medicare Secondary Payor Questionnaire as applicable for retention in imaging system.
• Calculate patient cost share and be prepared to collect via phone or make payment arrangement and document account with collection efforts accordingly.
• Contact patient via phone (with as much advance notice as possible, preferably 72 hours prior to date of service) to confirm or obtain missing demographic information, quote/collect patient cost share, and instruct patient on where to present at time of appointment.
• Receive and record payments from patient for services scheduled.
• Utilize appropriate communication system to facilitate communication with Patient Access team and other hospital departments as necessary.
• Ensure appropriate documentation is entered in standard format on the patient record. This should be performed in the applicable Health Information System (i.e. Meditech) and if necessary any other subsidiary systems if they are not automatically updated.
• Contact physician to resolve issues regarding prior authorization or referrals.
• Research Patient Visit History to ensure compliance with payor specific payment window rules.
• Perform insurance verification and pre-certification follow up for prior day’s walk-in admissions/registrations and account status changes by assigned facility as per guidelines.
• Communicates with hospital-based Case Manager as necessary to ensure prompt resolution of pre- existing, non-covered, and re-certification issues.
• Complete ABN’s (Advanced Beneficiary Notice) on all Medicare patients.
• Always serves to fulfill the mission; practices and adheres to the Code of Conduct/Standards of Behavior/Values.
• Demonstrates knowledge and understanding of organizational policies, procedures and systems.
• Participates in process improvement initiatives.
• Performs other duties as assigned.
• Knows fire, disaster and safety procedures and regulations as pertains to the work area.

Formal Education:

• High School Diploma or GED required.

Work Experience:

• 1 year to < 2 years related experience Patient Access Rep with PMC/Parrish Healthcare. Also, the employee must exceed all work standards:
• Quality - 99% accuracy on IPlan Assignment
• Finance – 100% of Goal
• Meet 120% Productivity requirements of the Central Unit Rep position
• Requires VP/ Executive Director and Patient Access Director approval of promotion to this position

Required Licenses, Certifications, Registrations:

• N/A

Full Time Benefits:
Eligible to participate in a number of PMC-sponsored benefits, including:

• Benefits Start on Day 1
• Health, Dental and Vision Insurance
• 403(b) Retirement Program
• Tuition Reimbursement/Educational Assistance
• EAP, Flex Spending, Accident, Critical and Other Applicable Benefits
• Annual Accrual of 152 Personal Leave Bank (PLB) Hours