Patient Access Representative III

West Tennessee Healthcare

About The Position

This position functions as a team lead or supervisor, providing day-to-day direction and oversight to Patient Access Services and serving as a resource to staff on highly complex issues and problem resolution. The role completes the financial clearance process within Patient Access and helps create the first impression of WTH’s services for patients, families, and external customers. It collects and documents information on behalf of patients and works with medical staff, nursing, ancillary departments, insurance payers, and other external sources to help families obtain healthcare and financial services. The role provides leadership and operational support, including scheduling, work assignment oversight, staff training and coaching, quality reviews, and assistance with policies and improvement plans. It also performs patient registration and financial clearance, including gathering demographic, financial, and clinical information; verifying insurance and authorizations; explaining coverage and financial assistance options; and collecting applicable patient payments. The position requires 3–4 years of healthcare or related experience. An associate degree in business, healthcare, or a related field is preferred; commensurate experience of two additional years beyond the minimum experience requirement may substitute.

Requirements

3–4 years of healthcare or related experience required.
Associate degree in business, healthcare, or a related field preferred, or commensurate experience of two years in addition to the minimum experience requirement.

Nice To Haves

Associate degree in business, healthcare, or a related field.

Responsibilities

Develop schedules to ensure adequate staffing across shifts for effective Patient Access Services operations.
Assign and oversee day-to-day work, provide leadership to staff, and work with department management to set standards and develop and execute improvement plans.
Assist with hands-on training for new employees and retraining or job-skill development for existing employees.
Alert management to processing backlogs and suggest ways to resolve them.
Coach and mentor less experienced team members on revenue cycle, payer, policy, and role-related issues.
Review and resolve complex accounts requiring advanced expertise and critical thinking.
Perform daily accuracy reports and quality assurance reviews of patient accounts as directed.
Obtain complete and accurate demographic, financial, and clinical information to help ensure maximum hospital reimbursement.
Provide input and assistance to Patient Access Services management in developing and implementing policies and procedures.
Interview patients and collect and record information necessary for pre-registration and registration as part of the financial clearance process.
Ensure the correct insurance payer plan choice and billing address are assigned in the automated patient accounting system, and verify relevant group and ID numbers.
Complete patient registration according to established policies and procedures, provide required disclosures and privacy information, and obtain relevant signatures.
Contact payers to verify insurance eligibility and complete and document automated eligibility verification when applicable.
Determine patients’ insurance types and educate them about coverage and coverage issues.
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.
Collect copayments, coinsurance, and deductibles according to pre-service and point-of-service collection policies and procedures.
Advise the next-level leader of possible postponement or deferral of elective or non-emergent admissions that have not been approved before the service date.
Maintain accurate files for pre-processing information as required.
Assist with cross-training in areas within Patient Access Services.
Perform related responsibilities as required or directed.