Patient Access Representative I - North Hospital Emergency Department

West Tennessee Healthcare

1d•Onsite

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 to patients and families and other external customers. The PAS Representative must be able to articulate information in a manner that patients, guarantors, and family members understand so they know what to expect and have an understanding of their financial responsibilities. This position assumes responsibility for collecting and documenting information on behalf of the patient. The PAS Representative may be responsible for completing the pre-registration, registration, insurance verification, benefits verification, certification, referral management, patient liability collections, and medical necessity check -- as well as interviewing patients and guarantors to obtain information to screen for financial counseling, verifying eligibility and corresponding benefit levels, coordinating referrals, and obtaining treatment authorizations. The PAS representative will also work with medical staff, nursing, ancillary departments, insurance payers, and other external sources to assist families in obtaining healthcare and financial service.

Requirements

High School Graduate, or equivalent

Nice To Haves

1-2 years of health care or related experience

Responsibilities

Maintain the best practice routine per department guidelines.
Maintain daily work queues at acceptable levels according to department policies.
Work correspondence daily to current.
Perform financial clearance process by interviewing patients and collecting and recording all necessary information for pre-registration and registration of patients.
Ensure that proper insurance payer plan choice and billing address are assigned in the automated patient accounting system.
Verify relevant group/ID numbers.
Complete the registration process according to established policies and procedures.
Inform families with inadequate insurance coverage regarding financial assistance through government and financial assistance programs.
Perform initial financial screening and refer accounts for financial counseling and/or appropriate eligibility assessments.
Ensure all referrals and treatment authorizations for all patient types have been obtained according to the outlined requirements.
Contact payers for approvals if referrals/authorizations are not obtained.
Complete initial medical necessity checks.
Refer to the designated area if medical necessity fails or if referrals/authorizations are denied.
Advise next-level leader of possible postponement or deferrals of any elective/non-emergent admission which has not been approved prior to service date.
Maintain accurate files for pre-processing information as required.
Investigate, resolve, and document patient problems in a timely and efficient manner.