Patient Access Rep

United Regional•Wichita Falls, TX

15h•Onsite

About The Position

The Patient Access Representative is responsible for ensuring the highest possible customer service is delivered to both internal and external customers. This role involves proactively approaching dissatisfied customers and implementing customer service recovery measures. The representative will conduct thorough searches of patient names against the Eclipsys Master Patient Index (EMPI) to prevent duplicate records or errors in assigning Medical Record Numbers (MRNs). They will follow policies and procedures for naming conventions, search practices, and MPI data element changes. The role requires utilizing all available systems to verify patient/family information, including collecting copies of driver's licenses and insurance cards. The representative will input third-party payer information, correctly assigning primary and secondary payers, and must meet departmental performance targets for write-offs, denials, and rejections. Patients will be preregistered in advance of their appointment/admission date. The representative will contact insurance companies to notify them of patient admissions within the next business day and in accordance with payer contract guidelines. They will collaborate with the Utilization Review department and physician's offices to ensure clinical requirements are met and document all benefits and pre-certification information. The role involves providing efficient documentation of time and contact persons when obtaining benefits and pre-certification data. Based on obtained benefit information, the representative will create an accurate good faith estimate letter and utilize resources to obtain CPT & Procedure Codes. They will provide patients/families with information on advanced directives, patient rights, and consent for treatment, obtaining appropriate signatures. The representative will prepare patient packets, complete charts, and scan necessary documents. They will quote patient co-share responsibilities (co-payments, deductibles, out-of-pocket amounts), negotiate payment options, and provide assistance applications to patients with inadequate funding. The role includes documenting receipts of funds, filing them, and reconciling petty cash daily. The representative will ensure Medicare Secondary Payer Questionnaires (MSPQ) are collected and accurately entered, and verify Medicare A/B and other coverage are correctly displayed in the registration system. Finally, the representative will complete special assignments in a timely manner, assist others, work under deadlines and pressure, and report trouble accounts to management positively.

Requirements

High School Diploma or equivalent.
Must be able to communicate effectively in English, both verbally and in writing.
Clerical skills and background is needed to perform the functions of the job.
Must type 40 wpm.
Good clerical, communication, spelling, and public relation skills are required.
Requires the use of office equipment, such as computer terminals, telephones, copiers, 10 key calculators and other various office equipment.
Having patience and understanding is a must.
Ability to work under pressure and stress.

Nice To Haves

Admitting, insurance, collections and medical terminology are helpful.
Previous admitting/registration experience is helpful and desired.
Past collection and insurance experience is desired.

Responsibilities

Ensures that highest possible customer service is delivered to both internal and external customers.
Proactively approaches dissatisfied customers and implements customer service recovery measures to satisfy displeased customers.
Conducts a thorough search of patient name against the Eclipsys Master Patient Index (EMPI) in order to eliminate the risk of duplicating or making errors in selecting the correct patient or establishing a new Medical Record Number (MRN).
Follows policy and procedures that govern the naming conventions, search practices and notification of changes to the MPI core data elements.
Utilizes all systems available to verify information provided by patients/families.
Collects a copy of the patients(s) or guarantor’s drivers’ license(s) and insurance card(s).
Inputs third party payer information, according to what plan is considered primary payer, secondary payer, etc.
Establishes the correct assignment of payer based on COB training materials.
Meets departmental performance targets associated with write offs, denials and rejections.
Preregisters patients 2 working days to 2 weeks in advance of appointment/admission date daily.
Contacts insurance company(ies) and notifies them of the patient’s admission within next business day of admission and/or in accordance with Payer’s contracted guidelines.
Works with Utilization Review department and physician’s offices to ensure that clinical requirements are obtained.
Enters all benefits and pre-cert information in the account notes as instructed.
Provides efficient documentation of time and person whom talked to when obtaining benefits and pre-certification data.
Creates an accurate good faith estimate letter based on benefit information obtained from the patient’s insurance company.
Utilizes all available resources to obtain CPT & Procedure Codes i.e. CPT/Procedure Code books, websites, Medical Records Coding Help Line ect.
Provides patient/family with information on advanced directives, patient rights, consent for treatment, and obtains appropriate signatures.
Prepares necessary patient packets and completes charts.
Scans insurance cards, patient identification cards, and other admitting documents.
Quotes patient’s co-share responsibility (co-payments, deductibles, & out of pocket amounts) to patient, negotiates payment options that lead towards compliance and minimizes collection expenses.
Provides assistance applications to all patients with no or inadequate funding.
Documents receipts of funds from patient and gives copy to patient at time of transaction.
Files receipt of funds in department files.
Reconciles petty cash count and reports overage/shortage to supervisor daily.
Follows established procedure to ensure that Medicare Secondary Payer Questionnaire (MSPQ) are collected and accurately entered into the registration system.
Ensures that Medicare A and/or Medicare B, along with any other applicable coverage, are shown in the correct position(s) on the Insurance Plan Screen in Eclipsys, and if not, to make the appropriate corrections.
Completes special assignments completely and in a timely manner.
Is quick to assist.
Demonstrates ability to work under deadlines and pressure.
Works with Management in a positive manner when reporting trouble accounts.
Performs all other tasks/responsibilities as necessary.