Lead Patient Access Rep

Driscoll Children's Hospital-posted 4 months ago
Full-time
Corpus Christi, TX
1,001-5,000 employees
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Where compassion meets innovation and technology and our employees are family. Thank you for your interest in joining our team! Please review the job information below. General Purpose of Job: This position reports to the Patient Access Service Director, through the Manager. This position is responsible for the support of the team functions necessary to accomplishing the objective of the service department. These include, but are not limited to functions under the categories of: patient accounting, patient scheduling & registration, verification of patients’ benefits, securing reimbursement via prior authorization / referrals or time of service collection, documentation of actions taken to collect out of pocket expenses and patient financial discharge. Essential Duties and Responsibilities: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or hospital administration as required. Maintains utmost level of confidentiality at all times. Adheres to hospital policies and procedures. Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines. Adheres and complies with customer service standards and dress code as set forth by the hospital and the department.

  • Answers the department telephone immediately or within three rings utilizing courtesy and patience
  • Greet patients and their families with courtesy and concern for their needs
  • Listens to customer needs and takes appropriate action as indicated
  • Gather patient demographic and financial information in a kind and courteous manner.
  • Reschedule patients upon patient request and notifies the patient’s physician.
  • Mark patient cancellations in the appropriate scheduling system and notify the patient’s physician.
  • Document telephone encounters.
  • Manage an appointment waiting list as indicated.
  • Call patients to confirm appointment times and offer any other pertinent information such as out of pocket expense, education, directions, parking information, etc.
  • Schedule patients for necessary procedures as indicated, using the appropriate scheduling system and obtain authorization for all planned services as indicted by insurance carrier.
  • Accurately create patient encounter in patient accounting systems utilizing the appropriate patient search criteria and interview method
  • Verify patient’s insurance benefit and document findings, this process should be completed in the appropriate timeframe for the service being provided; refer to EMTALA guidelines
  • Refer cases for financial screening as indicated.
  • Obtain Authorization or Referral for services as indicated
  • Make a clear copy of picture identification and insurance cards, front and back.
  • Explain all business forms and obtain signatures
  • Issue Patient Rights and Responsibilities and the hospitals Notice of Privacy Practice as indicated
  • Issue patient identification card or wristband identification as appropriate.
  • Escort the patient to the appropriate service area
  • Review schedule/pre-registrations/registrations to identify potential duplicate medical record numbers.
  • Identify patients with multiple same day visits to match demographic and insurance data for each pre-registration.
  • Review patient demographic and financial data to ensure accuracy
  • Validate verification and documentation of insurance eligibility and coverage for anticipated procedures.
  • Validate insurance authorizations was obtained from referring physicians when necessary/appropriate.
  • Validate insurance authorizations was obtained from payors when necessary/appropriate.
  • Validate documentation of patient insurance benefit, co-payment, deductible and co-insurance agreements in preparation for collection at the time of service or prior to discharge.
  • Close recurring accounts as indicated
  • Reviews pre-registration list for no shows and cancellations to reschedule or cancel account as indicated.
  • Reconcile Census with Census Reports and Registration forms as indicated.
  • Review documented notes for payment requirements; explains insurance benefits as quoted to us by their insurance carrier, and collects patient’s out of pocket expenses
  • Refer cases for financial screening as indicated.
  • Prepare hospital receipt for payment received.
  • Validates address and phone number
  • Ensures all paperwork is complete and all insurance cards and identification cards are copied for business record
  • Document all actions taken at discharge in patient accounting system.
  • Cash box will be in balance at all times
  • Payments received will be receipted and accounted for at all times
  • The department Standard Operating Procedure for cash handling will be followed.
  • Coordinates shift staffing
  • Coordinates workflow
  • Ensures the financial discharge process is being followed by the entire team
  • Ensures customer needs both internal and external are being exceeded and issues addressed to the satisfaction of the customer
  • Performs team and shift change debriefs for the purpose of communicating important information and performance measures in a consistent manner as directed.
  • High school diploma or general education degree (GED); or six months related experience and/or training; or equivalent combination of education and experience.
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