Patient Access Representative 3 (On-Site)

University of Miami•Doral, FL

5d•Onsite

About The Position

The Patient Access Representative 3 (On-Site) oversees the registration and financial clearance activities that will facilitate reimbursement for services rendered by the department and serves as functional expert for department peers. This role involves obtaining, confirming, and entering demographic, financial, and clinical information necessary for financial clearance of scheduled patient accounts. It also includes verifying insurance, confirming eligibility, obtaining authorizations, and notifying patients of liabilities prior to the date of service. The position requires maintaining accurate records, recommending new approaches for performance enhancement, and adhering to University policies. Department-specific functions include serving as a lead resource, ensuring smooth patient flow, providing supervisory coverage in the absence of a supervisor, and projecting a welcoming professional demeanor. The role requires interacting effectively with patients of all ages and the healthcare team, coordinating a wide range of functions using multiple systems simultaneously, performing pre-service validation, assisting patients with self-serve technology, and coordinating patient flow. It also involves conducting critical communication with patients or legal guardians regarding legal, ethical, and compliance documents, serving as a gatekeeper for insurance verification and obtaining referrals/authorizations, providing financial counseling, explaining benefits, creating estimates, collecting patient financial responsibilities, and promoting effective communication with providers and schedulers. The role handles a high volume of calls, collects and processes currency, reconciles cash drawers, and makes bank deposits. It also assists the department in meeting key performance indicator goals and maintains strong communication with the healthcare team to ensure a seamless patient experience. The position requires recognizing, analyzing, solving, and de-escalating issues, ensuring physical distancing, troubleshooting unique situations, and being cross-trained to float across all Front-End Revenue Cycle and Clinical Support functions. Knowledge of healthcare regulatory guidelines and compliance requirements is essential. Specific area requirements include understanding the unique characteristics of the Emergency Room, Admitting, CTU, Hospital-Based Clinics, Practice-Based Clinics, and Remote-Based call center operations, with flexibility for rotating schedules including evenings, weekends, and holidays. This list of duties is not exhaustive and may be expanded as needed.

Requirements

High School Diploma or equivalent
Minimum 3 years of relevant experience required
Learning Agility: Ability to learn new procedures, technologies, and protocols, and adapt to changing priorities and work demands.
Teamwork: Ability to work collaboratively with others and contribute to a team environment.
Technical Proficiency: Skilled in using office software, technology, and relevant computer applications.
Communication: Strong and clear written and verbal communication skills for interacting with colleagues and stakeholders.
Any relevant education, certifications and/or work experience may be considered.

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 prior to date of service and collects funds.
Maintains appropriate records, files, and accurate documentation in the system of record.
Recommends new approaches to management for enhancing performance and productivity.
Adheres to University and unit-level policies and procedures and safeguards University assets.
Serves as Lead resource and functional expert.
Ensures smooth patient flow.
Provides supervisory coverage in the absence of Supervisor.
Identifies and recommends new approaches to management for enhancing team performance and productivity.
Projects a welcoming professional demeanor.
Interacts and works effectively with patients of all ages, and the healthcare team to ensure a favorable first impression and positive patient experience.
Coordinates wide range of functions from prearrival to discharge utilizing multiple systems including but not limited to: EPIC MyChart, Grand Central ADT, Cadence, Prelude, Radiant, OP Time, Care Everywhere, Resolute, Nice inContact Communication, and Aria Oncology simultaneously and independently to service patients promptly in a fast paced, constantly changing environment.
Performs pre-service validation prior to patient’s appointment for in person or virtual visits.
Assists patients in navigating self-serve technology options including but not limited to MyChart and Self check-in kiosks, in person or remotely.
Coordinates patient flow to ensure timely check-in and arrival to service area.
Obtains, confirms, and accurately enters and updates demographic, financial, and clinical HIPAA protected information.
Reviews real time eligibility insurance responses and/or master contract tool and updates coverages as needed.
Conducts critical communication with patients or legal guardian facilitating the understanding of and obtaining signature on legal, ethical, and compliance related documents.
Serves as gatekeeper, performs insurance verification, and obtains referrals and/or authorizations as needed.
Provides financial counseling services at check-in, explains benefits, creates estimates, and notifies patients of self-pay liabilities including co-pays, deductibles, co-insurances, global self-pay packages, and previous balances for both hospital technical and professional components and collects thereby reducing AR, Bad Debt, and collection costs by collecting patient’s financial responsibility upfront.
Promotes the use of effective methods of communication and collaborates with providers and clinical team schedulers in coordinating and scheduling complex follow up care onsite or remotely.
Handles high volume of incoming and outgoing calls promptly.
Answers and triages incoming calls, listens to patient/customers’ needs, responds to questions, provides helpful solutions, directs calls, and documents messages using appropriate software in accordance with established protocol.
Collects and processes large amounts of currency and performs end of day cash-drawer reconciliation and timely bank deposits.
Assists department in meeting all established key performance indicator goals: Co-pay, Previous Balances, Estimate Collections, Patient Satisfaction, Accuracy Rates, and Processing Time.
Maintains a close working relationship and open communication with all members of the healthcare team to ensure a seamless check in, check out, clinic flow and positive experience for patients and caregivers.
Recognize, analyze, solve, and de-escalate issues that may arise during workday by applying sound judgement and critical thinking.
Ensures proper physical distancing is always maintained following established guidelines.
Works with healthcare team to resolve unique situations and troubleshoot issues.
Cross trained to carry out all Front-End Revenue Cycle and Clinical Support functions and able to float across all areas and assist as needed.
Knowledge of health care regulatory guidelines and compliance requirements including but not limited to: OSHA, HIPAA, JC, AHCA, EMTALA, and CMS.
Must possess a good understanding of the unique characteristics and operations of the Emergency Room to proficiently support.
Proficient knowledge of ASAP module.
Must be flexible and adjust to rotating schedules evenings, weekends, and holidays.
Able to perform ADT functions (as described under Admitting section) afterhours, weekends, and holidays.
Must adhere to PPE requirements as dictated by the specific situation.
Must possess a good understanding of the unique characteristics and operations of Admitting to proficiently support the area.
Proficient knowledge of ADT module.
On-call and rotating schedule for evenings, weekends, and holidays.
Explains and obtains patient acknowledgment for all required regulatory documents including but not limited to the HIPAA Facility Directory Form, and CMS MOON, HOON, and IMM notices.
Obtains information from patient to complete Patient Self Determination Checklist and collects and scans pertinent documents.
Responsible for obtaining, confirming, and documenting eligibility and benefits, and providing health plan admission notification.
Responsible for pre-admissions log to include benefits, specialty, and financial clearance.
Coordinates with bed control on bed availability.
Collaborates with Transfer Center on all incoming transfers to finalize transfer requests.
Responsible for processing admissions orders received via in-basket messaging.
Extensive collaboration with providers, nursing unit, and utilization review department in coordinating admissions.
Must possess a good understanding of the unique characteristics and operations of CTU to proficiently support the area.
Must possess a good understanding of the unique characteristics and operations of the hospital-based department/clinic/division to proficiently support the area.
Must possess a good understanding of the unique characteristics and operations of the practice-based department/clinic/division to proficiently support the area.
Must possess a good understanding of the unique characteristics and operations of remote based call center operations to proficiently support all Front-End Revenue Cycle and Clinical Support remote functions.