Patient Access Representative 3 (On-Site) (H)

University of Miami•Palm Beach Gardens, FL

4d•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 obtains, confirms, and enters 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 any issues. The position also collaborates with scheduling departments, obtains necessary authorizations, pre-certifications, and referrals, and notifies patients of liabilities prior to the date of service, collecting funds. The role requires maintaining appropriate records and documentation, serving as a lead resource for lower-level Patient Access Representatives, and recommending new approaches for enhancing performance and productivity. Adherence to University and unit-level policies and procedures and safeguarding University assets is also required. Department-specific functions include 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 from prearrival to discharge utilizing multiple systems simultaneously, and performing pre-service validation. It also involves assisting patients with self-serve technology, obtaining signatures on legal and compliance documents, performing insurance verification, obtaining referrals and authorizations, providing financial counseling, explaining benefits, creating estimates, and collecting patient financial responsibilities. The position promotes effective communication, collaborates with providers and schedulers, handles a high volume of calls, answers and triages calls, provides solutions, and documents messages. It also involves collecting and processing currency, performing cash-drawer reconciliation, and making bank deposits. The role assists the department in meeting key performance indicator goals, maintains a close working relationship with the healthcare team, and resolves issues by applying sound judgment and critical thinking. Ensuring proper physical distancing, working with the healthcare team to resolve unique situations, and cross-training for Front-End Revenue Cycle and Clinical Support functions are also part of the role. Knowledge of healthcare regulatory guidelines and compliance requirements is essential. Specific area responsibilities are outlined for ER, Admitting, CTU, Hospital Based Clinic, Practice Based Clinic, and Remote Based operations, each with unique characteristics and support requirements, including on-call duties and flexibility for rotating schedules, evenings, weekends, and holidays. This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.

Requirements

High school diploma or equivalent
Minimum 3 years of relevant experience
Knowledge of generally accepted accounting procedures and principles.
Skill in completing assignments accurately and with attention to detail.
Ability to process and handle confidential information with discretion.
Ability to work independently and/or in a collaborative environment.
Ability to communicate effectively in both oral and written form.
Subject to potential contact/exposure to pandemics and patients with contagious diseases.
Able to be available 30 minutes prior to opening and after clinic ends, which fluctuates depending on clinic and provider, in addition to weekends, evenings, holidays, and during disastrous events (e.g., hurricanes, pandemics, etc.)
Able to float and provide coverage without advance notice based on daily organizational needs, including working in offsite locations, tents or having to come onsite if working remotely.
Onsite presence may be required to fulfill role regarded as vital in the delivery of healthcare services regardless of environmental conditions.
Knowledge of health care regulatory guidelines and compliance requirements including but not limited to: OSHA, HIPAA, JC, AHCA, EMTALA, and CMS.
Outstanding interpersonal and customer service skills with a commitment to service excellence.
Excellent critical thinking, analytical, troubleshooting, and problem-solving skills.
Computer literate with the ability to acquire proficiency utilizing multiple systems and technology.
Able to handle multiple tasks, software systems, and technologies simultaneously in a fast paced, constantly changing environment.
Ability to work as an integral team member under minimal supervision, in a fast-paced, complex, and highly stressful environment.
Knowledge of generally accepted accounting principles with excellent mathematical and cash management skills.
Ability to establish and maintain effective working relationships with physicians, co-workers, other departments, and patients of all ages, and from across a broad range of cultural and social economic backgrounds.
Skill in completing assignments accurately with attention to detail.
Ability to work independently and/or in a collaborative environment.
Adherence to punctuality and attendance standards, remaining flexible to meet departmental needs and ensure appropriate clinic flow.
Any relevant education, certifications and/or work experience may be considered.

Nice To Haves

Proficient knowledge of ASAP module.
Proficient knowledge of ADT module.

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.
Serves as a lead resource for lower level Patient Access Representatives.
Recommends new approaches to management for enhancing performance and productivity.
Adheres to University and unit-level policies and procedures and safeguards University assets.
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 that must be presented and thoroughly explained to the patient prior to services being rendered including but not limited to: to Consent for Treatment and Conditions of Admissions, Advance Directives, HIPAA Notice of Privacy, No Surprise Billing, Good Faith Estimate, Off Campus Medicare Co-insurance and Advance Beneficiary Notices, and Medicare Secondary Payer Questionnaire.
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.