Patient Access Representative 2 Full Time Bascom Palmer Eye Institute Miami, FL

University of Miami•Miami, FL

3d•Onsite

About The Position

The Patient Access Representative 2 (On-Site) registers patients for clinical services by obtaining pertinent information, verifying insurance benefits, explaining pertinent documents, and collecting payments. This role is responsible for obtaining, confirming, and entering demographic, financial, and clinical information necessary for financial clearance of scheduled patient accounts. It involves contacting patients' families or physicians' offices to obtain missing insurance information, verifying insurance and confirming eligibility, and notifying patients and referring physicians of failed eligibility. The position also requires collaboration with scheduling departments, obtaining necessary authorizations, pre-certifications, and referrals, notifying patients of liabilities, collecting funds, and maintaining appropriate records and documentation.

Requirements

High School Diploma or equivalent/relevant experience, certification or license
Minimum 2 years of relevant experience required
Excellent verbal and written communications skills in English.
Must possess excellent, critical thinking, analytical, troubleshooting, problem resolution, and customer service skills.
Excellent mathematical and cash management skills.
Must be able to function independently and exercise sound judgment in making decisions consistent with departmental guidelines/objectives.
Ability to handle multiple tasks simultaneously and float to multiple areas as needed
Punctuality, attendance, and flexibility essential in order to meet departmental needs and ensure appropriate clinic flow.
Excellent interpersonal skills and ability to work effectively with physicians, co-workers, other departments and patients of all ages, and from across a broad range of cultural and social economic backgrounds.
Ability to work as an integral team member under minimal supervision, in a fast-paced, complex and highly stressful environment
Ability to coordinate, prioritize, and organize work and patient flow.
Ability to show tolerance and sensitivity in stressful situations and safeguard confidential information in accordance with established policies and HIPAA laws.
Computer literate and ability to use multiple systems and acquire proficiency in the following electronic systems: UChart Cadence/Prelude/Enterprise Billing, Passport HealthWorks Compliance Checker, Availity, RIS-PACS, CaneCare, UMCare, Intellidose, MCSL, Experian and all online verification systems used by contracted payors.

Nice To Haves

Bi-Lingual (English/Spanish, English/Creole, English/French, English/Arabic) a plus.
Knowledge of medical terminology preferred.

Responsibilities

Obtains, confirms, and enters demographic, financial, and clinical information necessary for financial clearance of scheduled patient accounts.
Contacts patients’ families or physicians’ offices to obtain missing insurance information.
Verifies insurance and confirms insurance eligibility of patient coverage benefits, notifying patient and referring physician in the event of failed eligibility.
Collaborates with scheduling departments to identify add-on patients.
Obtains necessary authorizations, pre-certifications, and referrals.
Notifies patients of liabilities and collects funds.
Maintains appropriate records, files, and accurate documentation in the system of record.
Adheres to University and unit-level policies and procedures and safeguards University assets.
Serve as Patient Advocate and Service Ambassador by providing a favorable first impression and proactive attention to internal and external customers in order to meet or exceed expectations, address concerns, and optimize experience.
Coordinate scheduling of all walk in, add on, and follow up appointments in accordance with established guidelines and in multiple systems, i.e. UChart Cadence/Prelude/Enterprise Billing, UMCare, and RIS/PAC.
Enter and/or update all pertinent data including demographics, financial, and referring physician information.
Interact with patients and collaborate with providers and clinicians to appropriately schedule appointments taking into account scheduling guidelines per division/specialty/provider, resource availability, special needs, timeframes, medical necessity, and payer and contractual guidelines.
Determine appointment type and utilize analytical skills to determine appropriate slot utilization and instances when overbooking is appropriate.
Obtain and document pertinent insurance verification information (i.e. CPT codes, service description, reason for visit, etc.) needed to obtain authorization/pre-cert in order to avoid denials and ensure financial reimbursement.
Coordinate multiple appointments with appropriate sequence and proper time allotted between appointments.
Communicate to patient the place of service where each appointment will take place (i.e. POS 11 vs. 22) and how it may impact his/her financial responsibility.
Perform ancillary/clinic support duties which vary by hospital departments and specialties (i.e. ER, Admitting, CTU, Imaging, Bariatrics, Dermatology, Infertility, Mental Health, OB GYN, Oral Surgery, Pediatrics, Plastic Surgery, etc.) that include but are not limited to the following: UChart Office Assistant functions and monitoring of Provider’s In Basket Messaging, Processing of Back to Work or School Requests, and Immunization Records, Scanning Imaging Results, Preparing Charts/Medical Records, Processing of Medical Record Release of Information, Prescription Refill Requests, Test Results Requests, Treatment Plans, Appt. Reminder Calls, Bump Lists, Surgery Scheduling, Coordination of External Referrals, Promotion and Sales of Over the Counter Products, Inventory and Ordering of Supplies, Ordering of DME products, Bed Assignments, Pre-certifications.
Perform all on-site patient access registration related functions promptly without compromising patient safety, quality, service levels, and reimbursement.
Obtain legal photo identification and (if applicable) insurance card (s), and validate patient identity and coverage (if applicable) prior to services being rendered thereby ensuring patient safety and financial reimbursement.
Scan ID, insurance card (s), advance directives, share of cost letters, and any other pertinent documents.
Obtain and/or verify that all demographic, financial, and insurance coverage information is accurate, up to date and complete, and that financial clearance has been obtained inclusive of all required referrals/authorizations.
Explain all applicable forms (i.e. Consent for Medical Treatment and Conditions of Admission, Acknowledgement of Receipt of Privacy Practices, Questionnaires, Important Message from Medicare, Advance Directives Checklist, and answer any questions patients’ may have pertaining to form(s) and established policies.
Obtain and witness all patient/guarantor signatures on all applicable consents and forms, and ensure that all initial and signature areas required have been completed and forms have been dated, timed and labeled.
Print out labels and/or any forms required by treatment area.
Complete check-in and registration process as rapidly as possible (without compromising quality or service level) in order to minimize the time patients must wait for treatment to begin.
Verify insurance eligibility, obtain all applicable referrals/authorizations/pre-certifications, and confirm that non-emergent visits have been financially cleared prior to services being rendered in order to ensure financial reimbursement.
Verify insurance eligibility and authorization requirements for walk-ins and add-ons utilizing multiple automated on-line resources or telephone.
Identify point of service (POS) 11 versus 22 and obtain verification and referral/authorization accordingly.
Provide patient/guarantor with detailed benefit and authorization requirements and co-pay, deductible, and co-insurance self–pay responsibility for POS 11 and 22.
Ensure that the appropriate payer has been selected (i.e. Indemnity, HMO, PPO, POS, Auto, W/C, etc.) and that all the required data elements and referrals and authorizations based on CPT, ICD 9, and services being rendered have been obtained and accurately entered in system in order to avoid claim rejections.
Refer non-contracted payers for single case negotiation.
Determine appropriate filing order if patient is covered by more than (1) payer.
Financially clear visits once insurance has been verified and referral/authorizations obtained.
Generate HAR (Hospital Account Record) for all services rendered at a point of service 22 (POS 22), and assigns HAR’s to appointments accordingly.
Comply and abide with all established UHealth policies and procedures related to Patient Access and State/ Federal regulations.
Complete the Medicare Secondary Payer Questionnaire (MSPQ) at time of scheduling prior to services being rendered and in accordance with Centers for Medicare & Medicaid Services (CMS) Federal regulations.
Utilize medical necessity software to determine if an Advance Beneficiary Notice (ABN) is applicable in order to produce and provide all Medicare patients with an ABN in accordance with CMS Federal regulations prior to services being rendered. Explain ABN in Study and Transplant.
Identify patients enrolled in a Study/Transplant program and validate that the account reflects the appropriate coverage(s) as it relates to the Study/Transplant program, in order to ensure accurate billing.
Identify and collect patient’s self-pay responsibility including co-pays, deductibles, co-insurances, self- pay discount rates, global packages, and previous outstanding balances for both technical and professional components in POS 11 and 22 clinics thereby playing a key role in reducing AR, Bad Debt, and Collection Costs by collecting patient’s financial responsibility upfront.
Exercise sound judgment so as not to delay treatment for emergency medical conditions and necessary stabilizing treatments, due to patient’s financial responsibility and collection efforts.
Determine and collect patient’s estimated financial responsibility for both POS 22 and POS 11 (i.e. deductible, co-payment, co-insurance, prompt payment discounts or global fee based on CPT/ICD9 codes).
Explain charges, fees, and previous balances for both technical and professional components.
Offer forms of payment including cash, checks, and credit cards.
Check for counterfeit bills when collecting cash and obtain authorization for all credit card transactions.
Post payment(s) as applicable for both POS 11 and 22, and issue system generated receipt(s).
Reconcile all collections and transactions at the end of the shift including initial cash bag funds.
Prepare daily deposit(s) for Med Finance, Main Cashier, or contracted armored pick up service.
Document any and all collection details including discounts, global fees and partial payments in system and select applicable billing indicators and FYI Global/Discount flags.
Provide upfront financial counseling services at time of check-in including identifying alternate funding resources, and establishing payment plans.
Advise patients of financial obligations and collect according to established guidelines and financial policies.
Identify alternate funding sources and offer global or discount.
Identify patients which have been deemed eligible for charity care or financial hardship and determine if services being rendered are encompassed in charity approval.
Assist patients in establishing payment plans.
Coordinate discharge process including identification and collection of additional self-pay charges, prompt scheduling of all follow up appointments, procedures, diagnostic testing, etc., appointment status update, voucher/facility fee reconciliation, and After Visit Summary (AVS).
Determine upon checkout/discharge any pending financial responsibility, and collect and post payment(s) accordingly.
Systematically reflect the checkout/discharge status by carrying out the checkout function and updating the appointment status to complete.
Check discharge orders and coordinate the prompt scheduling of any and all follow up appointment(s)/procedure(s), diagnostic or ancillary services ordered.
Print and provide the patient with an After Visit Summary (AVS).
Obtain applicable vouchers, facility fee, and/or secondary forms and screen for accuracy.
Comply with all standard operating procedures established to support key metrics and quality assurance initiatives that contribute toward prompt billing and increased cash flow.
Identify systematic warning flags/messages and populate required data elements in order to eliminate by- passed warnings/errors and avoid a negative impact on downstream revenue cycle processes.
Monitor and clear patient work queues on a daily basis to ensure data integrity, prompt billing and minimal AR days.
Populate any and all required data to ensure the checklist at the end of the arrival process reflects as complete for each category.
Account for and enter accurate charges within established time frame.
Enter charge codes and amount of units accurately and within (1) business day of services being rendered.
Perform daily reconciliation to identify missing charges and follow up with clinicians to obtain in order to ensure all rendered services are accounted for and billed.
Maintain a 3 calendar day maximum lag in order to ensure prompt billing and increased cash flow.
Perform end of day duties to ensure the accuracy of all appointment/visit statuses in system.
Review DAR and identify appointments that are not in completed status.
Contact clinicians to confirm appropriate status of each appointment.
Update status accordingly (i.e. no-show, left without being seen, canceled, etc.).
Perform other duties as assigned based on departmental needs.