HIM/PATIENT ACCESS REPRESENTATIVE (Per Diem)

Description

Job Summary

HIM/Patient Access Representative: This position is responsible Patient Access duties including, but not limited to appointment scheduling, pre-registration, registration, insurance verification, prior-authorization, telephone coverage, explains and obtains signatures on forms, up-front collections, registration follow-up, and customer service.   In addition, this position is responsible for maintaining, preserving, and releasing confidential health records in accordance with specified state agency, federal requirements, and hospital policies and is accountable for performing clerical and administrative functions to support the main HIM Department and billing services for both the Clinic and Hospital.

Essential Functions

HIM Specific Job Duties:

• Release medical records per facility policies, California Privacy Laws, and HIPAA regulations.

• Performs chart reconciliation and prepares the documents for scanning.

• Follow-up on any missing documents and reporting of missing documents to the department head and HIM Director.

• Accurately scan and title medical records received from other facilities, as well as our own, to the designated patient’s encounter and document name in the Electronic Health Record (EHR).

• Performs 5% audit of scanned documents and reports mis-scans or missing images to the department director prior to destruction of the hard copy of scanned charts.

• Assist physicians in record completion.

• Maintains an accurate and efficient filing of the old paper charts and stores the scanned documents in the Chart Room in an orderly manner.

• Purge medical records per retention directives.

• Have an excellent understanding of medical record processes.

• Maintain the medical record storage area.

• Is the key contact of the HIM department.

• Has excellent telephone and customer service attributes.

• Demonstrates knowledge and understanding of the rules of confidentiality, chart analysis, terminal digit filing, scanning into the Electronic Health Record (EHR), and all policies and procedures associated with the job duties in a Health Information Management Department.

• Assist with referrals and obtaining prior-authorization when assigned.

Patient Access Specific Job Duties:

• Registers patients by verifying identity and interviewing patients or representative in a pleasant, professional, and timely manner according to department practices.

• Validates existing data related to prior registrations by asking patient to repeat all data and update appropriately in the EHR.

• Ensures all necessary demographic, guarantor, financial data, and emergency contacts is obtained and accurately entered into the Electronic Health Record (EHR). 

• Enrolls the patient to the patient portal.  Validates the email address.

• Selects the correct patient type and medical services.

• Scans all necessary insurance information, including insurance cards, personal identification, driver’s license, physician order, etc. into EHR.

• Identifies appropriate payor sources and verifies eligibility by thoroughly reading the report generated in the EHR or online.  Contacts health plan via telephone when electronic means of determination are not available.

• Obtains prior authorization for outpatient services.

• Checks to ensure authorization has been obtained prior to services being rendered. If authorization is not in place, reschedule the service. Creates an estimate and discusses intent to proceed with a Non-Authorized Service as needed. Scans all appropriate documentation into the EHR.

• Notifies health plans when patients transition to Observation, Inpatient, or Swing when necessary.

• Completes timely Emergency Care Reporting to health plans requiring notification.

• Reviews and understands the insurance eligibility reports to determine patients’ upfront costs.

• Refers all private pay, underinsured patients, and Hospital Presumptive Eligibility applications to the Financial Counselor.

• Utilizes price estimation tool, when applicable, to provide the most accurate estimate to patients.

• Initiates patient financial conversations with respect and privacy. Creates estimates for services and delivers to patient. Collects estimated amount due.

• Documents all estimates, conversations, and collections in EMR.

• Answers and appropriately routes all incoming telephone calls.

• Holds sufficient understanding of insurance protocols for orders, authorizations, referrals, co-payments, deductibles, allowed amounts, etc.

• Maintains and updates knowledge regarding all types of insurance and health plan coverage, utilizing reference materials provided, when necessary.

• Preforms cashier functions for all patients who present cash, check or credit card as payment for services.

• Maintain accurate records of cash, check, and credit card payments.

• Understands and follows all regulatory requirements including but not limited to: Emergency Medical Treatment and Labor Act (EMTALA), Health Insurance Portability and Accountability (HIPAA), and Red Flag Rules.

• Performs alternate provider workflow for non-staff providers including: NPI check and OIG Exclusion List checks. Documents all information in EHR.

• Informs patients of and obtains signatures timely for all registration forms including but not limited to: Conditions of Admission, Patient Rights and Responsibilities, Notice of Privacy Practices, Acknowledgment of Patient Information on Advance Directives, Notice of Patient Visitation Policy, Patient Registration Form, Important Message from Medicare, and Medicare Observation Notice.

• Possesses knowledge of and can explain all forms, required registration information, and procedures as needed.

• Creates armbands, labels, and other documentation as necessary. Places armbands on patients following appropriate policy and procedure.

• Obtains worker’s compensation accident information when applicable. Calls patient employer to verify employment. Obtains all insurance information from employer timely. Contacts insurance company to gather claim information. Enter all information into EHR.

• Completes Medicare Secondary Payor Questionnaire and documents responses in EHR.

• Explains to Medicare patients options printed on the Advance Beneficiary Notice (ABN) and assist the patient completing the form.  Scans and documents the ABN into the EHR.

• Assists patients with filling out medical records release forms. Verifies patient identity and documents on forms. Sends all Release of Information (ROI) forms to Health Information Management (HIM).

• Schedules patients for outpatient and walk-in services. Assists in scheduling patients at check out.

• Utilizes patient schedules to prepare for patient appointments when possible, including but not limited to missing registration items, patient estimates, forms, schedules, and notes.

• Promptly answers phone calls at workstation and directs to appropriate area as necessary. Acts as District Operator coverage outside of business hours or as needed.

• Displays exceptional customer service with patients, visitors, and peers by addressing and treating all with respect and understanding.

• Attends and engages in department meetings, projects, teams, trainings, and committees.

• Utilizes interpreter service to communicate with patients when needed.

• Performs quality checks, reports, audits, note-taking, and other clerical tasks for department when requested.

• Works EHR work queues during each shift.

• Follows up on all items including pre-registration and pre-admission missing registration items, emergency room visit missing registration items, appointment missing registration items, admission missing registration items, discharged patient missing registration items, returned mail, and claim edits.

• Completes all job functions with discretion ensuring patient privacy and confidentiality.

• Responds to emergency calls and pages emergency announcements in accordance with emergency response policies.

• Performs hospital front desk duties. Receives visitors, obtains names and nature of business, and provides information and direction.

• Works shift and area as assigned on schedule. Is cross trained in different coverage areas of Patient Access and HIM when requested.

• Enters safety, feedback, and disruptive event reports as needed.

• Utilizes critical thinking at all times.

• Actively looks for solutions and shares ideas for improvement with team.

• Maintains proactive and positive communication with management team, peers, and patients at all times.

• Exhibits professionalism in appearance, speech and conducts following department dress policy while on shift.

• Works on special projects as assigned.

• Acts as mentor and operational trainer to new team members in conjunction with the Registration Lead. Trains, validates, and competency checks new team members. Communicates progress of trainee to Lead and supervisor.

• Demonstrates the District’s Values in performance and behavior.

• Complies with the District’s policies and procedures.

• Check for duplicate medical records numbers.

• Assists with referrals and pre-authorization tasks.

• Other duties may be assigned.

Physical Requirements, Safety, and Environmental Conditions  

• Follows safe work practices, takes an active interest in preventing injury or illness and promoting a safe and healthful environment for self and others, and complies with Hospital and governmental safety regulations.

• Must function independently, have personal integrity, have flexibility and the ability to work effectively with other personnel, clients, and support agencies

• Sits, stands, bends, lifts, walks, and moves intermittently during working hours and ability to lift up to 20 lbs.

Compliance

• Assumes personal responsibility to comply with all Federal, State and local laws governing business conduct, conducts business in an ethical and trustworthy manner, and displays the qualities and characteristics of a professional at all times when dealing with patients, visitors, physicians, volunteers, and fellow employees.

• Exemplifies the Seneca Core Values in all aspects of work responsibilities and demonstrates these values to fellow employees and supervisors.

Quality of Work

• Assumes responsibility for professional customer service when working with the public, physicians, and other departments. 

• Strives for excellence in following policies and procedures.

• Utilizes positive communication skills when interacting with people who work for, are serviced by, or associated with the hospital, to ensure that persons receive the highest degree of attention and courtesy.

• Maintains confidentiality of information received in the department and throughout the hospital by complying with strict confidentiality regulations per HIPAA requirements.

• Promotes professional growth of self and co-workers by participating in on-the-job training, continuing education and assisting with training of new employees.

Why Seneca Healthcare District?

Seneca employees are united in our quest to improve the health and well-being of our patients, and we empower each of our team members to fulfill this mission and reach their full potential regardless of job title or experience level.

To this end, we offer:

• Leading benefits package for full-time and part-time employees, inclusive of health, prescription drug, dental, vision and life insurance coverage.
• Sponsored 403(b) plan, with up to 3% matching contribution, and eligibility to participate in the District-funded pension program following one year of service.
• Accrued Paid Time Off (PTO) and Extended Sick Leave (ESL).
• A "One Team" culture of deep respect and admiration across all teams and functions, regardless of role or background.

Job Qualifications

• High school diploma or equivalent.

• One-year minimum of general clerical experience preferred.

• Proficient typing speed at minimum of 35 words per minute with accuracy.

• Knowledge of medical terminology and anatomy and physiology is desirable but not required.

• Must possess the ability to communicate effectively both orally and in writing, to include legible handwriting, correct grammar, and spelling.

• Must possess good working command of the English language.

• Must possess the ability to operate standard office equipment and be computer literate.

• Previous cash collections and financial institution experience desirable but not required.

Salary : $20 - $27