Patient Access Representative I- Kirkland Cancer Center

West Tennessee Healthcare

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 Patient Access Services 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 handle 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.
One to two years of healthcare or related experience preferred.

Nice To Haves

One to two years of healthcare or related experience.

Responsibilities

Maintain department best-practice routines and keep daily work queues within acceptable levels under department policies.
Work correspondence daily and keep it current.
Interview patients and collect and record information needed for pre-registration and registration as part of the financial clearance process.
Assign the correct 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 approvals 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.