Patient Access Rep II - Healthclub Admin

Tenet • Detroit, MI

7d

About The Position

The Patient Access Rep II works under limited supervision and serves as a resource to Patient Access Representative I staff. The role provides training and orientation on department methods, procedures, and policies, contributes input on departmental policies and procedures, and helps resolve complex or sensitive patient access and insurance issues. The position works with patients and families, government agencies, hospital departments, and third-party payers to resolve eligibility and insurance verification problems, and assists the Financial Counselor with identifying payment sources.

The role registers and schedules patients for health services, verifies insurance coverage and benefits, obtains authorizations and referrals, estimates patient liability, and collects copayments and deductibles in accordance with hospital policies. It obtains and verifies accurate patient, medical, demographic, and insurance information; ensures required forms and signatures are completed; and supports timely and accurate billing through account monitoring, reconciliation, and resolution of bill holds and rejected transactions. The role also coordinates tests and services, assists uninsured patients with applications or payment arrangements, communicates facility policies and billing procedures, participates in bed management and special projects, and performs Lead duties when requested.

DMC Rehabilitation Institute of Michigan specializes in rehabilitation medicine and research, including spinal cord injury, brain injury, stroke, amputee, orthopedic, and catastrophic injury care. It also operates outpatient sites throughout southeast Michigan focused on sports medicine and orthopedics. The organization describes its work environment as supportive and collaborative, with advanced technology and a healthcare community dedicated to patient care.

Requirements

• High school diploma.
• 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, reimbursements, and copayment and deductible collections.

Nice To Haves

• Associate degree in a related area desired.

Responsibilities

• Serve as a resource to Patient Access Representative I staff.
• Provide training and orientation on department methods, procedures, and policies.
• Provide input for establishing departmental policies and procedures.
• Resolve complex eligibility and insurance verification problems in collaboration with patients or families, government agencies, hospital departments, and third-party payers.
• Assist the Financial Counselor with financial counseling to help patients identify and obtain payment sources.
• Resolve complex or sensitive issues and recommend appropriate actions.
• Participate in bed management as defined by 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 support 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 and ensure required consent, regulatory forms, and applicable MSP questionnaires are completed and signed.
• Obtain accurate insurance, medical, and demographic information for patient admission or pre-admission.
• Determine copayments and deductibles and collect payment 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 about facility policies and billing procedures and obtain information needed for efficient registration and accurate billing.
• Collect referrals and authorizations, attempting to secure telephone referrals when necessary.
• Complete telephone registrations as appropriate.
• Resolve bill holds promptly to meet the five-day bill-hold timeline 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 when requested and other duties as assigned.

Benefits

• Medical, dental, vision, and life insurance.
• 401(k) retirement savings plan with employer match.
• Paid time off (PTO).
• Career development and continuing education opportunities.
• Health savings accounts and healthcare and dependent flexible spending accounts.
• Employee Assistance Program.
• Employee discount program.
• Voluntary benefits including pet insurance, legal insurance, accident and critical illness insurance, long-term care, elder and childcare, and auto and home insurance. Eligibility may vary by location and employment status.

What This Job Offers

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