Lead Patient Account Specialist

Driscoll Children's Hospital•El Paso, TX

3d•Onsite

About The Position

This position reports to the Central Patient Access Services (CPAS) Supervisor. 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 referral creation, insurance verification, authorization procurement, pre-service patient contact and documentation of actions taken to collect out-of-pocket expenses. Exercising appropriate age-specific communication skills and safety practices when interacting with customers, patients, and families.

Requirements

High school diploma or general education degree (GED); or six months related experience and/or training; or equivalent combination of education and experience.

Responsibilities

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.
Listens to customer needs and takes appropriate action as indicated.
Respond to urgent emails and voicemails promptly.
Gather patient demographic and financial information in a kind and courteous manner.
Document telephone encounters.
Call patients to confirm appointment times and offer any other pertinent information such as out-of-pocket expense, education, directions, parking information, etc.
Conduct warm transfers as needed.
Place outbound calls to referring providers or guardians (for self-referrals) to obtain missing and validate existing information.
Facilitate referral intake.
Attempt to reach patient guardian to communicate any pre-visit instructions as necessary.
Complete any additional ancillary tasks.
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 cases for financial screening as indicated.
Complete all authorization procurement work functions as indicated.
Accurately collect and enter patient demographics into patient accounting systems as indicated.
Populate referral data elements into Epic Referral Record as indicated.
Complete all pre-service work functions on items in the Epic work queue in accordance with defined policies and procedures.
Complete documentation in Epic according to Driscoll Health System and department documentation guidelines.
Collect, submit and file documents as appropriate.
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 and payors when necessary/appropriate.
Reviews pre-registration list for cancellations and notify department as indicated.
Identify patients that are missing any pre-registration items.
Check for referral minimum data set elements.
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.
Determine if patient is responsible for any payment of service and document how payment is calculated and received.
Refer cases for financial screening as indicated.
Prepare hospital receipt for payment received.
Validates address and phone number.
Ensure all paperwork is complete and all documents are correctly filed or attached to patients record.
Cash box will be in balance at all times.
Payments received will be receipted and accounted for at all times.
Meet with supervisor to discuss issues and identify solutions.
Identify training needs and/or barriers.
Maintain staff interactions and assist staff with questions, troubleshooting problem accounts and training.
Assist the supervisor with triaging Epic work queues throughout the day to ensure prioritization, and minimal backlogs.
Coordinates shift staffing and workflow.
Ensures customer needs both internal and external are being exceeded and issues addressed to the satisfaction of the customer.
Performs team debriefs for the purpose of communicating important information and performance measures in a consistent manner as directed.
Assist other staff as needed when workloads are high or absences occur.
Assist supervisor to complete quality reviews and training as needed.