Patient Access Representative:

Pioneers Medical Center•Meeker, CO

11d•Onsite

About The Position

The Patient Access Representative is responsible for obtaining pre-authorizations for imaging, reviewing insurance eligibility, deductibles, coinsurance, and copays, and informing patients of their financial responsibility. This role works closely with the clinical team to gather necessary documents for the pre-authorization process, submitting requests via insurance portals, fax, or phone. The representative communicates denials to the appropriate provider or department, ensuring accurate and timely completion of requests to maintain quality patient care. They will also be trained on and utilize the Athena/Meditech Authorization Management tool, cross-train in hospital and clinic registration and discharge, and may be required to obtain pre-certification for hospital and swing bed admits, as well as review and complete Emergency Department registrations. Maintaining strict confidentiality and adhering to HIPAA guidelines are crucial. The role involves documenting account actions, adhering to PMC's employee manual, and contributing to continuous quality improvement. The representative will also participate in educational activities and staff meetings.

Requirements

High school diploma or equivalent required.
Current BLS required within six (6) months of transfer or hire.
Kind and professional demeanor.
Professional and well-groomed appearance at all times.
Communicate positively and effectively, both written and verbally, with patients, family, and staff.
Demonstrate effective organizational skills in an evolving environment.
Work with honesty, compassion and integrity at all times.
Understand and adhere to the scope of service for the department and this position.
Understand and adhere to all of PMC’s policies and procedures.
Understand and adhere to PMC’s Code of Conduct.
Adhere to the strictest confidentiality and HIPAA regulations.
Demonstrate a commitment to building and sustaining a diverse, inclusive, and equitable working environment.
Ability to remain calm and efficient in emergency situations.
Demonstrate strong problem-solving skills.
Demonstrate strong emotional intelligence.

Nice To Haves

Revenue Cycle courses and continuing education as provided.
Annual Medicare Fraud and Abuse Education.
Medicate Secondary Payer documentation.
Certification as a Revenue Cycle Specialist through the American Association of Healthcare Administration Management (AAHAM) or certification as a Certified Revenue Cycle Representative (CRCR) through Healthcare Financial Management Association (HFMA) is desired within two (2) years of employment.
Knowledge of medical billing practices, including ICD-1-, CPT, and HCPCS codes desired.

Responsibilities

Obtains pre-authorizations for imaging.
Reviews information regarding insurance eligibility, deductibles, coinsurance, and/or copays for patients.
Informs patients of their financial responsibility either via phone or mail.
Works closely with clinical team to obtain various clinical documents to complete the pre-authorization process.
Submits requests via insurance portal, fax, or phone.
Communicates denials to appropriate provider or department.
Completes requests accurately and timely to ensure quality patient care.
Understands the Athena/Meditech Authorization Management tool and is able to troubleshoot issues.
Cross-trains extensively in the areas of hospital and clinic registration and discharge.
May be required to obtain pre-certification information on hospital and swing bed admits.
May be required to review and complete Emergency Department registrations.
Documents appropriate information on accounts on which action has taken place.
Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
Conducts self in accordance with PMC’s employee manual.
Makes suggestions and helps with continuous quality improvement in all department processes.
Maintains up-to-date guidelines to ensure responsibilities of the essential job functions are adequately outlined for training purposes.
Participates in educational activities, staff meetings, and in-services as required.