Patient Access Advocate III-Emergency Department-CDS

Presbyterian Healthcare Services • Rio Rancho, NM

7d • $16 - $22 • Onsite

About The Position

The Patient Access Advocate III provides registration of patient accounts for government and commercial accounts on date of service for scheduled and unscheduled visits. Perform registration functions, including updating of demographics, insurance verification, authorizations, collection of point of service liabilities and documentation of benefit analysis and registration information within the ADT system. Confirm and follow up on authorization for scheduled visits and make certain account being registered has accurate information to ensure clean billing. Provide coverage to other areas as needed to minimize overtime and guarantee the patients receive services as needed without registration delays. Assist in the shadowing of Patient Access candidates and assist in training new hires upon their completion of the Patient Access Academy. Must possess a strong knowledge of Medicare (CMS) guidelines, as well as other Compliance Regulatory guidelines applicable to Patient Access. Assist the patient with financial assistance and governmental programs for which the patient may qualify. Monitor accounts to identify any duplications and correct prior to patient receiving services to ensure patient safety. Provide the highest level of customer service to patients/family at time of service through registration interactions as well as providing wayfinding to patients and/or visitors

Requirements

• High school diploma/GED
• Internal Candidates: 3 years experience in healthcare setting with 2 year of Patient Access and/or billing, plus strong customer service background.
• Pass Patient Access Advocate III Advancement test.
• Strong understanding of insurance and financial processing of accounts.
• Extended understanding of medical terminology and billing codes (DRG, ICD-10, CPT, HCPCS)
• Proficient in EPIC ADT system
• Requires extensive knowledge of the customer encounter process which may include registration, healthcare practices, financial guidelines, billing requirements and coordination of benefits.
• Knowledge in Microsoft Office Products.
• Demonstrated strong keyboarding skills, ensuring efficient data entry and documentation.
• Pass EPIC proficiency test required with a 85% score at completion of the Epic Training class.

Nice To Haves

• CHAA, CHAM or other industry equivalent certification preferred.

Responsibilities

• Customer Service and Caring Practices: Ability to provide exceptional patient experience for patients and patient families by using CARES, AIDET and EPE tools. Addresses and attempts to appropriately resolve complaints in the moment by using key words at key times and de-escalation processes. Ability to manage conflict and appropriately request the help of a supervisor when needed. Acts as mentor for new hires. Implement PROMISE and CARES behaviors in every encounter. Educates patients for whom they speak regarding insurance benefits and liabilities. Ensures accounts are financially cleared at time of service through account review to alleviate patient concerns over hospital financial matters
• Encounter Components: Performs the patient registration process. Manage the accurate collection of patient data which includes but is not limited to; Obtain/confirm and enter demographic and other financial information, not obtained during pre-registration/financial clearance process, necessary for account completion. Review Urgent/Emergent admission accounts for notification and financial clearance of scheduled and urgent/emergent admissions. Obtain missing insurance information, to include policy number, group number, date of birth, and insurance phone number if not already identified in account. Verify insurance for eligibility and benefits using online electronic verification system or by contacting payer directly. Initiate authorizations if one has not been started. Review of accounts falling within the work queues to ensure the insurance information contains accurate policy ID#s, Group Name and Numbers, Subscriber information, Authorization numbers, as well as correct payer and Coordination of benefits prior to date of service. Reports trends back to supervisor to improve departmental quality. Accurately document actions taken in the system of record to drive effective follow-up and ensure an accurate audit trail. Maintain ongoing knowledge of authorization requirements and payer guidelines. Maintain a strong knowledge of Medicare (CMS) guidelines as it relates to admissions and outpatient services. Ensuring compliance with admissions forms, benefit entitlement verification, and billing requirements. Ensure accurate completion of MSPQ at time of service if not completed during financial clearance process. Daily focus on attaining productivity standards; recommend new approaches for enhancing performance and productivity when appropriate. Monitor and track Data Quality program to ensure errors are corrected at time of service. Maintain appropriate records, files, and timely and accurate documentation in the system of record. Other duties as assigned
• Financial Accountabilities: Collects identified patient financial obligation amounts including residual balance if applicable. Collect liability from patient at time of service. Educate patients on financial assistance, charity or other programs that may be available. Refers as appropriate to on site Financial Advocate or to the Financial Advocacy Center
• Patient Relations Complete any information missing from the account to ensure accuracy at time of visit. Transparency with patients through communication of patient liabilities.
• Quality Improvement: Perform assigned patient care responsibilities, which may include but not limited to: Cooperate fully in all risk management activities and investigations. Report promptly any suspected or potential violations to laws, regulations, procedures, policies, and practices, and cooperate in related investigation. Conduct all transactions in compliance with all company policies, procedures, standards, and practices. Demonstrate knowledge of all applicable compliance and legal requirements of the job based on the scope of practice of the position.
• C.A.R.E.S Behaviors: Demonstrates CARES behaviors of Collaborate, be Accountable, Respect, Engage and Serve to all whom you encounter.

Benefits

• All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
• Wellness Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED