Senior Patient Access Representative-(CSON)

UTHealth Houston•Houston, TX

7d•Onsite

About The Position

This position is responsible for mentoring other employees as a team leader, scheduling patient appointments, ensuring medical necessity compliance, verifying eligibility, and posting payments. The role involves obtaining demographic, insurance, and financial information from patients, explaining required forms, and ensuring medical necessity compliance. It also focuses on protecting the financial integrity of the facility by collecting patient liability, establishing payment arrangements, discussing payment options, and screening for eligibility. The representative will complete complex financial counseling, identify alternative resources for financial reimbursement, verify insurance eligibility and benefits, and ensure all notifications and authorizations are completed within required timeframes. Additionally, the role includes posting payments, generating receipts, monitoring and resolving patient account issues, performing account analysis, and completing quality reviews for process improvement. As a team leader, the individual will ensure daily processes are complete, schedule employees, answer questions, and assist with orientation and training. Effective and professional communication with various stakeholders, including physicians, care management, ancillary departments, nursing units, physician's office staff, insurance companies, patients, and their families, is crucial. Thorough and accurate documentation, adherence to university policies and procedures, and promotion of professional growth through continuing education and mentorship are also key aspects of this position.

Requirements

High School Diploma or equivalent required
4 years of experience in a hospital or medical business office setting required
Exerts up to 50 pounds of force occasionally and/or up to 20 pounds frequently and/or up to 10 pounds constantly to move objects.
Employees must permanently reside and work in the State of Texas.

Nice To Haves

None

Responsibilities

Schedules patient appointments and enters required information in the computer system in an accurate and timely manner.
Obtains demographic, insurance and financial information from patient or guarantor.
Enters information in computer system with a high degree of accuracy.
Explains all required forms to the patient or guarantor and obtains the necessary signatures.
Ensures medical necessity compliance by obtaining necessary data, reviewing Compliance System, communicating information to patient or guarantor and obtaining necessary signatures.
Protects the financial integrity of the facility by collecting patient liability, establishing payment arrangements, discussing payment options and screening for eligibility.
Completes complex financial counseling including the review and submission of charity applications.
Identifies alternative resources for financial reimbursement.
Verifies insurance eligibility and benefits and ensures all notifications and authorizations are completed within the required timeframes.
Posts payments in the computer system and generates the appropriate patient receipts.
Monitors, reviews and resolves patient account issues on assigned reports.
Performs account analysis and trending.
Completes quality review and monitors for process improvement opportunities.
Functions as a team leader in the department by ensuring daily processes are complete, scheduling employees, providing answers to employee questions and assisting in employee orientation and training.
Communicates in an effective and professional manner with Physicians, Care Management, ancillary departments, nursing units, physicians ' office staff, insurance companies, as well as patients and their families (all Patient Access customers).
Completes thorough and accurate documentation.
Adheres to all university policies, procedures, and standards, within budgetary specifications, including time management, supply management, productivity, and accuracy of practice.
Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.
Performs other duties as assigned.