BASIC FUNCTION:

The Patient Access Representative II is responsible for verification of patient demographic and financial information in addition to preparing the account for billing upon patient discharge. Activities are related to interaction with third party payers for verification of insurance benefits, interviewing patients to verify admission information and inform them of their financial responsibility, data input to prepare account for billing, securing a payment source for patients with no insurance coverage, and performing cashier duties.

EDUCATION AND EXPERIENCE REQUIREMENTS:

Education: High School diploma or equivalent required. Associate’s degree preferred.

Experience: 5 years patient registration, business office or billing experience in a healthcare setting is preferred.

Certification: Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) preferred.

RESPONSIBILITIES OF THE POSITION:

Patient and Financial Information

• Verification of patient demographic and financial information in addition to preparing the account for billing upon patient discharge and provides such information to physician offices when requested.

• Interaction with third party payers for verification of insurance benefits, interviewing patients to verify admission information and inform them of their financial responsibility, data input to prepare account for billing, securing a payment source for patients with no insurance coverage, and performing cashier duties.

• Performs verification, eligibility, precertification of benefits and coverage; HMO contracts through various agencies, Medicare and Blue Cross eligibility and benefits through the OMNIPRO system, Medicaid through the EMEVS system on a daily basis and contact employers, Worker’s Compensation, commercial and no-fault carriers.

• Visit patients in-house to gather missing demographic, financial information and insurance on all inpatient admissions.

• Assists patients with no third party payment source with financial obligations and advises patients with co-payments or deductibles of their financial responsibility.

• Visits patients in-house to make appropriate financial arrangements, secures a signed payment agreement, advise them of deductibles and copayments due on discharge.

• Provides patients with no third party payment source with a Medicaid application and a list of documents required for the application process, completes the Medicaid application process and submits the application to the County Department of Social Services. Screens and reviews eligibility criteria and assists with Charity Care program.

• Interviews patients at time of pre-admission testing to verify demographic and financial information and explain their financial obligations, advises patients and their families regarding questions about insurance coverage or assistance available to them.

• Completes and sends bills on a monthly basis to any alternative level of care patients in-house who must pay a monthly contribution toward their Medicaid coverage, or to patients who have no payment source.

• Prepares documentation for the cashier when patients are discharged detailing any financial or demographic information that must be obtained and any payments that should be collected.

• Prepares inpatient account for billing, inputs data and updates any changes or additions of demographic or financial information in the ACTION system.

• Checks in-house census daily to assure that insurance plans are set up appropriately and monies appropriated correctly.

• Completes a financial contact sheet on each patient and documents any special billing and payment instructions.

• Pulls discharged accounts on a daily basis and forwards to the Business Office.

• Facilitates in gathering accurate patient billing information.

• Performs collections of patients with outstanding accounts receivable. Accurately estimates the patient liability (copayments, deductibles, coinsurances, deposits, etc. via obtaining accurate demographic and financial information.

• Receives and processes patient payments. Maintains necessary petty cash to properly service and receive payments.

• Answers patient inquired regarding their liability and being able to explain the variables involved.

• Properly receipting and forwarding all copies of patient payment receipts posting to the patient’s account in Soarian Financials.

• Perform end of day duties closing and reconciliation duties in Soarian Financials and reconcile deposit slips.

• Schedule and coordinate patient appointments, in advance per the guidelines to maximize reimbursement and allow surgeons ample time to review test results, for pre-admission testing and a variety of departments based on the physician’s orders and the needs of the individual patient, communicate with the patient and the Pre-Admission Testing (PAT) Center to facilitate the appropriate flow of patients.

• PAT should not exceed 16 patients per day, patients should not be double-booked and an appointment sheet is prepared for each patient outlining areas where testing is to occur, time patient is scheduled in each area to ensure appropriate patient flow and delays do not occur.

• Verifies to determine if applicable tests have been performed in the acceptable time frames and obtains copies of test reports in lieu of repeat testing.

• Distributes daily PAT schedule sheets to the PAT Center, all ancillary departments, and the Patient Registration Office a day prior to the PAT appointment.

• Coordinates PAT for heart catheterization patients with the Cardiac Catheterization Lab and pre-procedure teaching session with the cardiac staff.

• Utilize available time blocs in each area to optimize services without overbooking.

• Coordinate certain procedures performed in Gastroenterology Unit which required interaction with the Radiology Department’s schedule.

• Accurately prepare the daily Operating Room, Delivery Room, Gastroenterology Unit and Eye Clinic schedule and deliver duplicates to appropriate ancillary departments.

• Assists with patient flow and access to services when necessary.

• Complete required training.

• Adhere to patient privacy policies and procedures, maintain confidentiality.

• Adhere to the Making Ellis Exceptional (MEE) Behaviors & Standards, and initiate, promote, and support change initiatives.

• Other duties as assigned.

Salary Range: $15.84-$22.96/hour Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.