Pre-Access Representative

Rochester Regional Health

4d•$19 - $29•Onsite

About The Position

The Pre-Access Representative will be responsible for handling the flow of scheduling calls. The essential responsibilities include pre-registration, scheduling, obtaining accurate demographics, providing exam preparations, and collection of appropriate authorizations/ICD codes in a courteous and efficient manner. They will be responsible for completing accounts with eligible insurance and authorization and complete patient pre-registration for scheduled procedures. The Representative will verify the patient payer eligibility, benefits/coverage, and estimated payment responsibility, confirm authorization requirements and secure on the account. The Representative will complete pre-registration phone interviews, to include obtaining necessary pre-registration information, including demographics, insurance information, and Medicare MSPQ, with documentation completed in the electronic medical record account. During the pre-registration interview, the representative will notify patient of potential financial responsibility and collect payment via phone, review issued Medicare ABN (Advance Beneficiary Notification), provide direction to facility and registration desk, and educate the patient regarding what items are required as part of the patients facility registration process.

Requirements

High School Diploma or GED required
Basic knowledge of Medical Terminology
Basic knowledge of EHR Programs (e.g. Meditech, eClinicalWorks, Medhost)
Basic knowledge of ICD-10, CPT, HCPCS codes and coding processes
Basic knowledge of Hospital billing processes and reimbursement
Superb customer service skills
Teamwork skills
Conflict resolution skills
Ability to learn and operate computer systems, printer, fax
Strong attention to detail
Efficient time management skills
Ability to multi-task
Excellent writing skills
Excellent oral communication skills
Excellent interpersonal communication skills
Exceptional organizational skills
Exceptional planning skills
Exceptional coordination skills
Exceptional collaborating skills
Strong understanding and comfort level with computer systems
Ability to work under stress
Ability to work in fast pace setting
Critical thinking skills
Knowledgeable of HIPPA regulations.

Nice To Haves

Associate’s degree or higher in healthcare administration, business administration, or related field desired
At least 1-3 years of customer service, administrative, and/or data entry experience preferred
One to two years of previous experience in hospital related field preferred
Experience with database software applications desired

Responsibilities

Answers phones from patients/customers professionally and responding to patient/ customer complaints.
Performs correct name inquiry and identifies patient according to policy and procedure without errors
Schedules patients/customers based on scheduling guidelines and medical appropriateness.
Receives a high volume of inbound calls with varying degrees of questions and concerns.
Obtaining and collecting all necessary information from the patient/ customer to schedule and register the patient for an appointment.
Consults with referring physician’s office to ensure written and/ or electronic orders exist and obtain them as needed.
Collects patient financial data, insurance, authorizations, and reference numbers.
Collects complete demographic information of patient including address, phone number.
Collects medical information to include patient complaint
Views insurance card(s) and scans into computer system reviewing for mandatory precertification and/or other third party payer requirements
Obtains Inpatient/ Observation patients precertification’s
Re works accounts to ensure accurate patient statuses
Collects complete financial information to include payer name, identification number, group number, subscriber name, guarantor name and address, and precertification numbers
Selects appropriate financial class and insurance code
Performs online real-time eligibility verification and registration scrub via AHIqa and makes changes to registration errors accordingly and in a timely fashion
Screens for insurance edibility via insurance websites, where appropriate
Completes Medicare Secondary Payer Questionnaire for all Medicare-eligible patients
Completes all admission forms required by Medicare
Verifies third party payer benefits and Worker’s Compensation according to departmental policy and procedure
Collects any patient-pay balances such as copay, co-insurance, or deductible at time of registration
Refers patient to Patient Financial Advocacy Program when appropriate and per departmental procedure
Balances cash draw, completes cash receipt, issues patient receipts and secures safe daily with no exceptions
Interviews the patient and/or family member either in person or by telephone to collect demographic, financial, and medical information
Explains consent information, obtains signatures, witnesses (legibly) with no omissions
Obtains copy of patient identification document(s)
Completes registration process within five minutes for preregistered patients and ten minutes for non-preregistered
Contacts physician offices to obtain and confirm patient information
Practices proficient customer service skills by greeting and treating all patients and staff with respect and discretion
Capable of empathizing with the circumstances of patients and families while maintaining and objective approach to the disposition of each account
Provides and explanation of any patient wait and responds to all patient requests. Notified manager of any patient wait times longer than 15 minutes.
Greets each patient and identifies self by name and role
Notifies the manager of incidents, errors or patient complaints
Maintains patient privacy and confidentiality at all times according to established procedures
Assess environment for safety hazards, which could harm patients, visitors, or other hospital employee’s and reports any found to facilities/housekeeping/manager
Exhibits professionalism in appearance, speech and conduct
Provide orientation and training of new staff
Attend Patient Access Meetings, Training Sessions, etc
Attend and actively participate in required and voluntary in-service educations
Participate in performance improvement within the organization and department