Patient Access Representative I - Jackson GYN

West Tennessee Healthcare

About The Position

This position is responsible for completing the financial clearance process within Patient Access Services and creating a first impression of WTH’s services for patients, families, and other external customers. The representative communicates information clearly so patients, guarantors, and family members understand what to expect and their financial responsibilities, and collects and documents information on behalf of patients. Responsibilities may include pre-registration, registration, insurance and benefits verification, certification, referral management, patient-liability collection, and medical-necessity checks. The representative may interview patients and guarantors to screen for financial counseling, verify eligibility and benefit levels, coordinate referrals, and obtain treatment authorizations. The role 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.
One to two years of healthcare or related experience preferred.

Nice To Haves

One to two years of healthcare or related experience.

Responsibilities

Maintain department 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 as part of the financial clearance process.
Assign the appropriate insurance payer plan choice and billing address in the automated patient accounting system.
Verify relevant group and identification numbers.
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 according to requirements; contact payers for approvals when they have not been obtained.
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 about 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 as required.
Investigate, resolve, and document patient problems in a timely and efficient manner.
Work with medical staff, nursing, ancillary departments, insurance payers, and external sources to assist families in obtaining healthcare and financial services.