Patient Access Representative I - UT Medicine

West Tennessee Healthcare

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 explains 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. The position may also interview patients and guarantors to screen for financial counseling, verify eligibility and benefit levels, coordinate referrals, and obtain 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.
Able to communicate information so patients, guarantors, and family members 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 in accordance with department policies.
Work correspondence daily and keep it current.
Interview patients and collect and record information necessary 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; verify relevant group and ID numbers.
Complete registration according to established policies and procedures.
Inform families with inadequate insurance coverage about government and financial assistance programs.
Conduct 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 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 of 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 as required.
Investigate, resolve, and document patient problems in a timely and efficient manner.