Patient Access Rep.

Trinity Health•Lavonia, GA

About The Position

Provides patient-focused customer service and performs outpatient and/or inpatient registration and insurance verification. Collects patient financial liability payments and ensures patients meet financial requirements, including Medicare medical necessity, payer pre-certifications, and referrals. Provides general information to hospital users, patients, families, and physician offices. The role researches, collects, and analyzes information; identifies opportunities; develops solutions; and leads issues through resolution. It collaborates on performance improvement activities based on program efficiency and patient experience outcomes and is responsible for distributing analytical reports. The position uses multiple system applications to analyze information, create reports, and develop educational materials, while applying knowledge of Trinity Health policies and processes to prioritize quality, confidentiality, and safety. Responsibilities may vary by functional role. PAR I is an entry-level role. PAR II performs PAR I duties and is cross-trained to perform activities in Pre-Service, the Emergency Department, and/or Bed Desk. A Patient Access Account Specialist uses specialized knowledge to support organizational areas, analyze and process items according to payer guidelines, resolve issues, ensure claims are billed accurately, and process payments promptly. The position maintains working knowledge of applicable laws and regulations, Trinity Health’s Integrity and Compliance Program and Code of Conduct, and related policies and procedures, and is expected to demonstrate honest, ethical, professional behavior and safe work practices. Trinity Health states its commitment to dignity, inclusion, person-centered care, and equal employment opportunity.

Requirements

High school diploma or equivalent.
HFMA CRCR or NAHAM CHAA certification required within one year of hire.
PAR I: At least one year of customer service experience.
PAR II: At least two years of hospital registration or insurance verification experience upon hire.
PAR II: Knowledge of medical terminology, diagnostic coding, and procedural coding.
PAR II: Ability to explain insurance benefits.
Patient Access Account Specialist: At least two years of hospital registration or insurance verification experience.
Ability to use multiple system applications for analysis, report creation, and educational materials.
Working knowledge of applicable federal, state, and local laws and regulations and relevant compliance policies and procedures.

Nice To Haves

Patient Access experience is preferred for PAR I.
Medical terminology and knowledge of diagnostic and procedural coding.
Insurance verification experience, ability to explain benefits, and ability to secure necessary authorization.

Responsibilities

Provide patient-focused customer service.
Perform outpatient and/or inpatient registration and insurance verification.
Collect patient financial liability payments.
Ensure patients meet financial requirements, including Medicare medical necessity, payer pre-certifications, and referrals.
Provide general information to hospital users, patients, families, and physician offices.
Research, collect, and analyze information; identify opportunities, develop solutions, and lead issues through resolution.
Collaborate on performance improvement activities based on program efficiency and patient experience outcomes.
Distribute analytical reports.
Use system applications to perform analysis, create reports, and develop educational materials.
Research and compile information for ad-hoc operational projects and initiatives.
Synthesize and analyze data; prepare detailed summaries and graphical presentations showing trends and recommending practical options or solutions.
Use program and operational data and measurements to define and demonstrate progress, return on investment, and impacts.
For PAR II, perform PAR I duties and cross-trained activities in Pre-Service, the Emergency Department, and/or Bed Desk.
For the Patient Access Account Specialist role, analyze, process, and edit items for correctness based on payer guidelines; resolve items; ensure claims are billed accurately; and process payments timely.
Maintain knowledge of applicable laws, regulations, compliance requirements, policies, procedures, and guidelines, and follow safe, ethical, and professional work practices.