Patient Access Representative

DRISCOLL HEALTH PLAN•Corpus Christi, TX

2d•Onsite

About The Position

This position reports to the Central Patient Access Supervisor. This position is responsible for the support functions necessary to accomplishing the objective of the service department at the servicing facility. These include but are not limited to functions under the categories of referral creation, insurance verification, authorization procurement, pre-service patient contact and documentation of actions taken to collect out of pocket expenses. Exercising appropriate age-specific communication skills and safety practice when interacting with customers, patients, and families. Attention to detail is required due to the complex nature of handling multiple specialties at multiple facility locations. These locations include Driscoll Children’s Hospital – Main Campus, Driscoll Children’s Hospital – RGV, CPSST locations – Laredo, McAllen, Brownsville, Pleasanton, Victoria, Harlingen, and Corpus Christi locations. Essential Duties and Responsibilities: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or hospital administration as required. Maintains utmost level of confidentiality at all times. Adheres to hospital policies and procedures. Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines. Adheres and complies with customer service standards and dress code as set forth by the hospital and the department. Attention to detail is required due to the complex nature of handling multiple specialties at multiple facility locations. These locations include Driscoll Children’s Hospital – Main Campus, Driscoll Children’s Hospital – RGV, CPSST locations – Laredo, McAllen, Brownsville, Pleasanton, Victoria, Harlingen, and Corpus Christi locations. Customer Service Duties Answers the department telephone immediately or within three rings utilizing courtesy and patience Listens to customer needs and takes appropriate action as indicated Respond to urgent emails and voicemails promptly Gather patient demographic and financial information in a kind and courteous manner Document telephone encounters. Call patients to confirm appointment times and offer any other pertinent information such as out of pocket expense, education, directions, parking information, etc. Conduct warm transfers as needed Respond to urgent emails and voicemails promptly, and respond to non-urgent emails and voicemails at the end of the day Place outbound calls to referring providers or guardians (for self-referrals) to obtain missing and validate existing information based on treatment location Facilitate referral intake based on treatment location Attempt to reach patient guardian to communicate any pre-visit instructions as necessary Complete any additional ancillary tasks Patient Accounting Duties Accurately create patient encounter in patient accounting systems utilizing the appropriate patient search criteria and interview method Verify patient’s insurance benefit and document findings, this process should be completed in the appropriate timeframe for the service being provided Refer cases for financial screening as indicated Complete all authorization procurement work functions as indicated Accurately collect and enter patient demographics into patient accounting systems as indicated Populate referral data elements into Epic Referral Record as indicated Complete all pre-service work functions on items in the Epic work queues in accordance with defined policies and procedures Complete documentation in Epic according to Driscoll Health System and department documentation guidelines Collect, submit and file documents as appropriate Quality Assurance Duties Review schedule/pre-registrations/registrations to identify potential duplicate medical record numbers. Update data discrepancies in Epic. Identify patients with multiple same day visits to match demographic and insurance data for each pre-registration. Review patient demographic and financial data to ensure accuracy Validate verification and documentation of insurance eligibility and coverage for anticipated procedures. Validate insurance authorizations was obtained from referring physicians and payors when necessary/appropriate. Reviews pre-registration list for cancellations and notify department as indicated. Identify patients that are missing any pre-registration items Check for referral minimum data set elements Patient Financial Duties Review documented notes for payment requirements; explains insurance benefits as quoted to us by their insurance carrier, and collects patient’s out of pocket expenses Determine if patient is responsible for any payment of service and document how payment is calculated and received Refer cases for financial screening as indicated. Prepare hospital receipt for payment received. Validates address and phone number Ensure all paperwork is complete and all documents are correctly filed or attached to patients record Cashiering Duties Cash box will be in balance at all times Payments received will be receipted and accounted for at all times

Requirements

High school diploma or general education degree (GED); or one to three months related experience and/or training; or equivalent combination of education and experience.
Attention to detail is required due to the complex nature of handling multiple specialties at multiple facility locations.
Ability to perform each essential duty satisfactorily.
Ability to exercise appropriate age-specific communication skills and safety practice when interacting with customers, patients, and families.
Ability to maintain utmost level of confidentiality at all times.
Ability to adhere to hospital policies and procedures.
Ability to demonstrate business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
Ability to adhere and comply with customer service standards and dress code as set forth by the hospital and the department.
Ability to answer the department telephone immediately or within three rings utilizing courtesy and patience.
Ability to listen to customer needs and take appropriate action as indicated.
Ability to respond to urgent emails and voicemails promptly.
Ability to gather patient demographic and financial information in a kind and courteous manner.
Ability to document telephone encounters.
Ability to call patients to confirm appointment times and offer any other pertinent information such as out of pocket expense, education, directions, parking information, etc.
Ability to conduct warm transfers as needed.
Ability to respond to non-urgent emails and voicemails at the end of the day.
Ability to place outbound calls to referring providers or guardians (for self-referrals) to obtain missing and validate existing information based on treatment location.
Ability to facilitate referral intake based on treatment location.
Ability to attempt to reach patient guardian to communicate any pre-visit instructions as necessary.
Ability to complete any additional ancillary tasks.
Ability to accurately create patient encounter in patient accounting systems utilizing the appropriate patient search criteria and interview method.
Ability to verify patient’s insurance benefit and document findings.
Ability to refer cases for financial screening as indicated.
Ability to complete all authorization procurement work functions as indicated.
Ability to accurately collect and enter patient demographics into patient accounting systems as indicated.
Ability to populate referral data elements into Epic Referral Record as indicated.
Ability to complete all pre-service work functions on items in the Epic work queues in accordance with defined policies and procedures.
Ability to complete documentation in Epic according to Driscoll Health System and department documentation guidelines.
Ability to collect, submit and file documents as appropriate.
Ability to review schedule/pre-registrations/registrations to identify potential duplicate medical record numbers.
Ability to update data discrepancies in Epic.
Ability to identify patients with multiple same day visits to match demographic and insurance data for each pre-registration.
Ability to review patient demographic and financial data to ensure accuracy.
Ability to validate verification and documentation of insurance eligibility and coverage for anticipated procedures.
Ability to validate insurance authorizations was obtained from referring physicians and payors when necessary/appropriate.
Ability to review pre-registration list for cancellations and notify department as indicated.
Ability to identify patients that are missing any pre-registration items.
Ability to check for referral minimum data set elements.
Ability to review documented notes for payment requirements; explain insurance benefits as quoted to us by their insurance carrier, and collect patient’s out of pocket expenses.
Ability to determine if patient is responsible for any payment of service and document how payment is calculated and received.
Ability to prepare hospital receipt for payment received.
Ability to validate address and phone number.
Ability to ensure all paperwork is complete and all documents are correctly filed or attached to patients record.
Ability to ensure cash box will be in balance at all times.
Ability to ensure payments received will be receipted and accounted for at all times.

Nice To Haves

Experience in a healthcare setting.
Familiarity with Epic systems.
Experience with insurance verification and authorization procurement.
Customer service experience.

Responsibilities

Support functions necessary to accomplish the objective of the service department.
Referral creation.
Insurance verification.
Authorization procurement.
Pre-service patient contact.
Documentation of actions taken to collect out of pocket expenses.
Exercising appropriate age-specific communication skills and safety practice when interacting with customers, patients, and families.
Maintaining utmost level of confidentiality at all times.
Adhering to hospital policies and procedures.
Demonstrating business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
Adhering and complying with customer service standards and dress code.
Answering the department telephone immediately or within three rings utilizing courtesy and patience.
Listening to customer needs and taking appropriate action as indicated.
Responding to urgent emails and voicemails promptly.
Gathering patient demographic and financial information in a kind and courteous manner.
Documenting telephone encounters.
Calling patients to confirm appointment times and offer any other pertinent information such as out of pocket expense, education, directions, parking information, etc.
Conducting warm transfers as needed.
Placing outbound calls to referring providers or guardians (for self-referrals) to obtain missing and validate existing information based on treatment location.
Facilitating referral intake based on treatment location.
Attempting to reach patient guardian to communicate any pre-visit instructions as necessary.
Completing any additional ancillary tasks.
Accurately creating patient encounter in patient accounting systems utilizing the appropriate patient search criteria and interview method.
Verifying patient’s insurance benefit and documenting findings.
Referring cases for financial screening as indicated.
Completing all authorization procurement work functions as indicated.
Accurately collecting and entering patient demographics into patient accounting systems as indicated.
Populating referral data elements into Epic Referral Record as indicated.
Completing all pre-service work functions on items in the Epic work queues in accordance with defined policies and procedures.
Completing documentation in Epic according to Driscoll Health System and department documentation guidelines.
Collecting, submitting and filing documents as appropriate.
Reviewing schedule/pre-registrations/registrations to identify potential duplicate medical record numbers.
Updating data discrepancies in Epic.
Identifying patients with multiple same day visits to match demographic and insurance data for each pre-registration.
Reviewing patient demographic and financial data to ensure accuracy.
Validating verification and documentation of insurance eligibility and coverage for anticipated procedures.
Validating insurance authorizations was obtained from referring physicians and payors when necessary/appropriate.
Reviewing pre-registration list for cancellations and notifying department as indicated.
Identifying patients that are missing any pre-registration items.
Checking for referral minimum data set elements.
Reviewing documented notes for payment requirements; explaining insurance benefits as quoted to us by their insurance carrier, and collecting patient’s out of pocket expenses.
Determining if patient is responsible for any payment of service and documenting how payment is calculated and received.
Preparing hospital receipt for payment received.
Validating address and phone number.
Ensuring all paperwork is complete and all documents are correctly filed or attached to patients record.
Ensuring cash box will be in balance at all times.
Ensuring payments received will be receipted and accounted for at all times.