Patient Access Representative II - Pulmonary Call Center

Nevada System of Higher Education•Arlington Heights, IL

1d•$20 - $29•Hybrid

About The Position

The Patient Access Representative II - Pulmonary Call Center is responsible for performing complete and accurate registration and/or admission functions across multiple access services areas or sites. This role aims to maximize reimbursement by providing timely and thorough information to all other providers and users of patient data. The representative will verify insurance requirements, obtain and understand insurance benefits, and collect non-covered fees. They will register and pre-register outpatients in various clinical and diagnostic locations, including but not limited to Busse Center, Emergency/Admitting Department, Immediate Care Centers, Laboratory, and Cancer Services. The position involves interacting with patients and their representatives to collect demographic, insurance, financial, and clinical data, offering interpreter services, and obtaining necessary consents and documents. The role also requires interpreting physician orders, informing patients of registration processes and privacy notifications, establishing financial responsibility, completing Medicare Secondary Payer questionnaires, and initiating Medicare Advance Beneficiary Notices. Additionally, the representative will streamline check-in processes, review physician orders for compliance, ensure financial protocols are met, refer patients to Financial Counselors, identify needs for Case Management involvement, and collaborate to resolve third-party payer requirements to minimize denials. Maintaining current knowledge of insurance requirements and providing support to primary care practices and specialty care providers are key aspects of this role. The position requires proficiency in CPT and ICD codes, utilization of online payer resources, and meeting monthly cash collection goals. Accuracy in registration, timely resolution of work queues, and maintaining a balanced cash drawer are essential. The role also involves coordinating scheduling for patients requiring multiple tests, explaining prep and wayfinding instructions, and collaborating with physician offices for appointments and tests at offsite locations. Electronic recording of patient account information in multiple hospital information systems, preparation of registration forms and documents, and notification of clinical departments of patient arrival are also required. The representative may also perform basic precepting for new hires, act as a resource team member for performance improvement, and serve as a super user for registration and scheduling systems. Responsibilities may extend to patient reception, assisting with wayfinding and transport needs, and supporting the clinical department as directed by the Manager of Patient Access. The role emphasizes customer service standards, adhering to AIDET principles, investigating and directing patient inquiries, and consistently demonstrating premier customer service and communication skills.

Requirements

High school diploma
Minimum of 1 year experience in a healthcare patient access department or hospital
Minimum 2 years of customer service work experience
Successful on-the-job completion of NCH Patient Access Specialist I and II competencies required.

Nice To Haves

Computer experience in a windows environment required
Ability to functionally navigate multiple computer software systems with accurate keyboard skills following computer security protocols
The interpersonal communication skills necessary to interview and interact with customers and physicians and to project a professional and compassionate concierge style of service to patients, patient families, physician’s and staff in person and on the telephone
Ability to work independently, exercising good judgment, and multi-task in a high stress, fast paced service environment with patients, patient’s family and physician’s
Detail oriented with good analytical problem-solving skills to appropriately register patients and schedule patient procedures
Ability to operate routine office equipment (facsimile, copiers, plate production, scanners, printers)
Ability to transact payments at time of service and maintain a cash drawer
Previous healthcare experience with regulatory compliance requirements, payer requirements, HIPAA privacy and security requirements, and general revenue cycle procedures required
Epic Registration and/or Scheduling experience preferred

Responsibilities

Performs complete and accurate registration and/or admission functions across multiple access services areas or sites.
Verifies insurance requirements and obtains and understands insurance benefits.
Collects non-covered fees.
Registers and pre-registers outpatients in multiple clinical and diagnostic locations.
Interacts with patients and their representatives to collect and interpret demographic, insurance, financial, and clinical data.
Offers and/or schedules interpreter services for patients when necessary.
Obtains and scans general consent for treatment, identification and insurance cards, Coordination of Benefits, and other appropriate documents.
Obtain and submit National Provider Identification (NPI) for providers not on staff ordering outpatient diagnostic tests.
Interpret physician orders for completeness and compliance with regulatory agencies and NCH policies.
Informs patients of registration processes and privacy notification, establishes financial responsibility to meet internal, regulatory or payer requirements.
Completes the Medicare Secondary Payer (MSP) questionnaire and discusses potential deferral of services.
Initiates the Medicare Advance Beneficiary Notice (ABN), as appropriate, and explains payer policies to patients.
Streamlines check in process for patient previously pre-registered and appropriately updates the account for changes identified upon arrival.
Reviews physician’s orders for compliance with the Illinois Department of Public Health (IDPH), and the Center for Medicare & Medicaid Services (CMS) regulations and NCH and medical staff office policies.
Ensures financial protocols and requirements are met.
Refers patients to Financial Counselors for identification of financial assistance options.
Identify clinical and financial criteria that require involvement of Case Management team or Financial Counseling.
Collaborate with internal and external customers to provide timely resolution to third party payer requirements prior to date of service.
Minimizes third party payer denials by verifying authorization of service prior to forwarding patients to service delivery areas.
Maintains current knowledge of insurance requirements communicated by email, memorandum, educational matrices and in-services.
Provides support to primary care practices and specialty care providers regarding utilization, authorization and referral activities.
Communicates effectively with service delivery areas when unresolved financial issues impact appointment schedules.
Proficient in the use of CPT and ICD codes, and utilizes online payer resources.
Utilize estimator to determine financial responsibility and attempt to secure all financial responsibility prior to the date of service.
Meet monthly cash collection goals as determined collaboratively by Department Director/Manager.
Maintain registration accuracy by meeting or exceeding expectations with 97% or higher accuracy score.
Resolve all work queues within Department standards determined time period to release bill holds to ensure timely reimbursement.
Log cash collected receipts and maintain balanced cash at all times.
Coordinates scheduling of service areas for patients requiring multiple tests.
Identify and assign electronic educational programs for scheduled services.
Explains patient prep and way finding instructions to patient.
Collaborates with physician offices to check-in appointments and schedule tests post-physician office visits at offsite NCH locations.
Electronically records all required and updated information on patient accounts in multiple hospital information systems according to Emergency Medical Treatment and Active Labor Act (EMTALA), the Health Insurance Portability and Accountability Act (HIPAA), payer, and other applicable regulations and standards.
Prepares all required patient registration forms, documents, charts and reports, labels, patient plates, identification bands, medical records forms, and other related documents for distribution to appropriate departments, physicians and clinical staff.
Notifies clinical department of patient’s arrival.
May do basic precepting for new hires and acts as a resource team member for performance improvement activities and a super user for various registration and scheduling related systems.
May perform as a patient receptionist/greeter.
Assists patients with way finding and transport needs.
Contacts clinical departments and scheduling staff as needed to assist in promoting the efficient flow of patients and prioritization of service scheduling and admissions.
Assists with other tasks to support the clinical department as determined by the Manager of Patient Access.
Performs customer service standards by adhering to the AIDET principles.
Investigate and direct patient inquiries or complaints to appropriate medical staff members and follow up to ensure satisfactory resolution.
Consistently demonstrate premier customer service and communication skills with all internal and external customers/contacts and ensure the patient and their family members have the best hospital encounter possible.
Adheres to all Northwest Community Hospital standards, policies, and procedures and reports compliance concerns to management staff.