Patient Access Representative I

West Tennessee Healthcare•Bolivar, TN

12d

About The Position

This position is responsible for completing the financial clearance process within Patient Access Services and creating the 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. The role collects and documents information on behalf of patients and may perform 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 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 so patients, guarantors, and family members understand it.
1–2 years of health care or related experience preferred.

Nice To Haves

1–2 years of health care or related experience.

Responsibilities

Maintain 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 the 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, 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.
Ensure referrals and treatment authorizations are obtained 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 if 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 as required.
Investigate, resolve, and document patient problems in a timely and efficient manner.