Patient Access Representative I- (Kirkland Cancer Center)

West Tennessee Healthcare•Kirkland, WA

About The Position

The Patient Access Representative I is responsible for completing the financial clearance process within Patient Access Services and creating a positive 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. The position may involve pre-registration, registration, insurance and benefits verification, certification, referral management, patient liability collections, and medical necessity checks. It also includes interviewing patients and guarantors to identify potential financial counseling needs, verifying eligibility and benefit levels, 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.
Ability to communicate information clearly to patients, guarantors, and family members.
Ability to collect and document patient information and coordinate financial clearance activities.

Nice To Haves

One to two years of healthcare or related experience preferred.

Responsibilities

Maintain best-practice routines and department work queues within acceptable levels, and process correspondence daily.
Interview patients and collect and record the information needed for pre-registration and registration as part of the financial clearance process.
Assign the proper insurance payer plan choice and billing address in the automated patient accounting system, and 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.
Obtain referrals and treatment authorizations for all patient types according to requirements; contact payers for approval 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 about possible postponements or deferrals 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.
Work with medical staff, nursing, ancillary departments, insurance payers, and external sources to assist families in obtaining healthcare and financial services.