Patient Access Representative I

West Tennessee Healthcare

About The Position

This position completes the financial clearance process within Patient Access Services and creates the first impression of WTH’s services for patients, families, and other external customers. The Patient Access Representative communicates information clearly so patients, guarantors, and family members understand what to expect and their financial responsibilities. The role collects and documents information on behalf of patients and may handle pre-registration, registration, insurance and benefits verification, certification, referral management, patient liability collections, and medical necessity checks. It may also involve interviewing patients and guarantors for financial counseling screening, verifying eligibility and benefits, coordinating referrals, and obtaining treatment authorizations. The representative works with medical staff, nursing, ancillary departments, insurance payers, and other external sources to help families obtain healthcare and financial services.

Requirements

High school graduate or equivalent.

Nice To Haves

1–2 years of healthcare or related experience preferred.

Responsibilities

Maintain the department’s best-practice routines and keep daily work queues at acceptable levels according to department policies.
Work correspondence daily and keep it current.
Interview patients and collect and record information needed for pre-registration and registration.
Assign the correct insurance payer plan choice and billing address in the automated patient accounting system.
Verify relevant group and identification numbers and complete registration according to established policies and procedures.
Inform families with inadequate insurance coverage about government and financial assistance programs.
Perform initial financial screening and refer accounts for financial counseling or appropriate eligibility assessments.
Ensure referrals and treatment authorizations are obtained for all patient types according to requirements, and contact payers for approvals when needed.
Complete initial medical necessity checks and refer cases to the designated area when medical necessity fails or referrals or authorizations are denied.
Advise the next-level leader of possible postponement or deferral of elective or non-emergent admissions that have not been approved before the service date.
Maintain accurate files for pre-processing information.
Investigate, resolve, and document patient problems in a timely and efficient manner.