Patient Access Representative II FT Days

Trane Technologies • Detroit, MI

8h

About The Position

Under limited supervision, the Patient Access Representative II serves as a resource to Patient Access Representative I staff, provides training and orientation on department methods, procedures, and policies, and contributes input to departmental policies and procedures. In conjunction with the Lead, the role resolves complex eligibility and insurance-verification issues by working with patients and families, government agencies, other hospital departments, and third-party payers. The representative also assists the Financial Counselor with financial counseling, helping patients identify and obtain payment sources and recommending appropriate actions for complex or sensitive issues.

The role participates in bed management under operating-unit policies and procedures; registers and schedules patients; obtains accurate insurance, medical, and demographic information; verifies coverage and benefits; analyzes authorizations and referrals; and calculates estimated patient liability. It reviews, monitors, and reconciles patient accounts, supports accurate billing, and ensures compliance with third-party payer requirements. The representative explains and obtains required forms, consent, signatures, and applicable MSP questionnaires, and assists uninsured patients with medical assistance applications, payment arrangements, and cash collections.

Additional duties include coordinating tests and services using current clinical guidelines; answering questions about facility policies and billing; collecting referrals and authorizations, including attempting to obtain telephone referrals; completing telephone registrations as appropriate; resolving bill holds within the five-day bill-hold period; correcting rejected transactions on user-specific Transmission, Control and Errors (TCE) reports; participating in special projects; communicating clinical, financial, and administrative information; and performing Lead duties when requested, along with other assigned duties.

Requirements

• High school diploma; an associate degree in a related area is desired.
• Two to three years of progressively more responsible experience in patient access, hospital registration, or a related area.
• Advanced knowledge of third-party payer requirements, reimbursements, and copayment and deductible collections.

Nice To Haves

• Associate degree in a related area.

Responsibilities

• Serve as a resource to Patient Access Representative I staff and provide training and orientation on departmental methods, procedures, and policies.
• Provide input for establishing departmental policies and procedures.
• Resolve complex eligibility and insurance-verification problems in conjunction with the Lead, contacting patients or families, government agencies, other hospital departments, and third-party payers as needed.
• Assist the Financial Counselor with financial counseling and help patients identify and obtain payment sources.
• Resolve complex or sensitive issues and recommend appropriate actions.
• Participate in bed management as defined by operating-unit policies and procedures.
• Register and schedule patients for health services and ensure the setting is appropriate for the services provided.
• Obtain accurate insurance, medical, and demographic information for patient admission or pre-admission.
• Verify insurance coverage and benefits, analyze authorizations and referrals, and calculate estimated patient liability.
• Review, monitor, and reconcile patient accounts to support accurate bill production.
• Ensure compliance with third-party payer requirements.
• Explain required forms and ensure consent, regulatory forms, applicable MSP questionnaires, and patient signatures are completed and obtained.
• Determine patient copayments and deductibles and collect payments according to hospital policies.
• Assist uninsured patients with medical assistance applications, payment arrangements, and cash collections.
• Coordinate scheduling of tests and services using current clinical guidelines.
• Answer patient questions about facility policies and billing procedures and obtain information needed for registration and accurate billing.
• Assist patients in completing necessary forms and obtain signatures as needed.
• Collect referrals and authorizations and attempt to secure telephone referrals when necessary.
• Complete telephone registrations as appropriate.
• Resolve bill holds in a timely manner to meet the five-day bill-hold period and reconcile and correct rejected transactions on user-specific TCE reports.
• Assist with and participate in special projects as assigned.
• Communicate clinical, financial, and administrative information.
• Perform Lead duties as requested and other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED