Patient Access Representative I

West Tennessee Healthcare•Dyersburg, TN

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 explains 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. Depending on the needs of the role, duties may include pre-registration and registration, insurance and benefits verification, certification, referral management, patient liability collections, medical necessity checks, financial screening, 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 can understand it.

Nice To Haves

1–2 years of healthcare or related experience preferred.

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 the information needed for pre-registration and registration.
Complete the financial clearance and registration process according to established policies and procedures.
Assign the proper insurance payer plan choice and billing address in the automated patient accounting system, and verify relevant group and identification numbers.
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 required referrals and treatment authorizations are obtained for all patient types; contact payers for approvals when needed.
Complete initial medical necessity checks and refer cases 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.
Work with medical staff, nursing, ancillary departments, insurance payers, and other external sources to assist families in obtaining healthcare and financial services.