Patient Access Rep II - Healthclub Admin Novi, MI

Tenet Healthcare•Detroit, MI

About The Position

The Patient Access Rep II works under limited supervision as a resource to Patient Access Representative I staff. The role provides training and orientation on departmental methods, procedures, and policies and contributes input to departmental policies and procedures. In conjunction with the Lead, the representative resolves complex eligibility and insurance verification issues involving patients and families, government agencies, other hospital departments, and third-party payers. The role supports financial counseling, assists patients in identifying payment sources, and resolves complex or sensitive issues. It registers and schedules patients, verifies coverage and benefits, obtains and analyzes authorizations and referrals, estimates patient liability, and reviews and reconciles patient accounts for accurate billing. The representative ensures compliance with payer requirements, obtains accurate insurance, medical, and demographic information, and explains and secures required consent and regulatory forms and signatures. The representative determines and collects copayments and deductibles, helps uninsured patients with medical assistance applications and payment arrangements, coordinates scheduling of tests and services, and answers questions about facility policies and billing. Additional duties include completing telephone registrations, resolving bill holds and rejected transactions, participating in bed management and special projects, communicating clinical, financial, and administrative information, performing Lead duties when requested, and completing other assigned duties.

Requirements

High school diploma; an associate degree in a related area is desired.
Two to three years of progressively more responsible experience in patient access, hospital registration, or a related area.
Advanced knowledge of third-party payer requirements, reimbursement, and copayment and deductible collections.

Nice To Haves

Associate degree in a related area.

Responsibilities

Serve as a resource to Patient Access Representative I staff and provide training and orientation on departmental methods, procedures, and policies.
Provide input for establishing departmental policies and procedures.
Work with the Lead to resolve complex eligibility and insurance verification problems by contacting patients or families, government agencies, other hospital departments, and third-party payers.
Assist the Financial Counselor with financial counseling and help patients identify and obtain payment sources.
Resolve complex or sensitive issues and recommend appropriate actions.
Participate in bed management according to operating unit policies and procedures.
Verify insurance coverage and benefits, obtain and analyze authorizations and referrals, and calculate estimated patient liability.
Review, monitor, and reconcile patient accounts to ensure accurate bill production.
Ensure compliance with third-party payer requirements.
Register and schedule patients for health services and ensure the setting is appropriate for the services provided.
Explain forms to patients and families; ensure required consent, regulatory forms, and applicable MSP questionnaires are completed correctly and signed.
Obtain accurate insurance, medical, and demographic information to admit or pre-admit patients.
Determine patient copayments and deductibles and collect payments according to hospital policies.
Assist uninsured patients with medical assistance applications, payment arrangements, and cash collections.
Coordinate scheduling of tests and services using current clinical guidelines.
Answer patient questions regarding facility policies and billing procedures, obtain information needed for registration and billing, assist with forms, and obtain signatures as needed.
Collect referrals and authorizations and attempt to secure telephone referrals when necessary.
Complete telephone registrations as appropriate.
Resolve bill holds in a timely manner to meet the five-day bill-hold requirement, and reconcile and correct rejected transactions on user-specific TCE reports.
Assist with and participate in special projects as assigned.
Communicate clinical, financial, and administrative information.
Perform Lead duties as requested and other duties as assigned.