Patient Access Rep II - Healthclub Admin

Tenet Healthcare • Detroit, MI

8d

About The Position

DMC Rehabilitation Institute of Michigan is seeking a Patient Access Rep II to support patient access operations. Under limited supervision, this role serves as a resource to Patient Access Representative I staff, provides training and orientation on department 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 and assists with financial counseling and sensitive patient matters.

The position registers and schedules patients, verifies insurance coverage and benefits, obtains and analyzes authorizations and referrals, calculates estimated patient liability, and reviews patient accounts for accurate billing. It ensures compliance with third-party payer requirements and applicable registration, consent, and regulatory documentation. The representative also assists patients with financial assistance applications and payment arrangements, collects payments, coordinates tests and services, addresses billing holds and rejected transactions, 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.

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, reimbursements, and copayment and deductible collections.

Nice To Haves

• Associate degree in a related area.

Responsibilities

• Serves as a resource to Patient Access Representative I staff and provides training and orientation on departmental methods, procedures, and policies.
• Provides input for establishing departmental policies and procedures.
• Works 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.
• Assists the Financial Counselor with financial counseling to help patients identify and obtain payment sources.
• Resolves complex or sensitive issues and recommends appropriate actions.
• Participates in bed management as defined by operating-unit policies and procedures.
• Verifies insurance coverage and benefits, obtains and analyzes authorizations and referrals, and calculates estimated patient liability.
• Reviews, monitors, and reconciles patient accounts to ensure accurate bill production.
• Ensures compliance with third-party payer requirements.
• Registers and schedules patients for health services and ensures the setting is appropriate for the services provided.
• Explains forms to patients and families and ensures required consent, regulatory forms, and applicable MSP questionnaires are completed and signed.
• Obtains accurate insurance, medical, and demographic information to admit or pre-admit patients.
• Determines copayments and deductibles and collects payments according to hospital policies.
• Assists patients without medical insurance in completing medical assistance applications, making payment arrangements, and handling cash collections.
• Coordinates scheduling of tests and services using current clinical guidelines.
• Answers patient questions about facility policies and billing procedures and obtains information needed for efficient registration and accurate billing.
• Assists patients with forms and obtains signatures as needed.
• Collects referrals and authorizations and attempts to secure telephone referrals when necessary.
• Completes telephone registrations as appropriate.
• Resolves bill holds in a timely manner, ensuring completion within the five-day bill-hold period, and reconciles and corrects rejected transactions on user-specific Transmission, Control and Errors (TCE) reports.
• Assists with and participates in special projects as assigned.
• Communicates clinical, financial, and administrative information.
• Performs Lead duties as 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 and 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.

What This Job Offers

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