Patient Access Representative |
| Location: | Crawfordsville, IN |
| Salary Range: | -- |
| Exempt/Non-Exempt: | Non-Exempt |
| Benefits: | Benefit Eligible |
| Type: | 40-Full Time |
| Facility: | St. Clare Medical Center |
| Description: | The Patient Access Representative performs a variety of duties in registration and scheduling. |
| Duties: | Registration
Registrar
- Verbally interviews patient and/or family in order to obtain registration information.
- Enters patient billing and clinical data.
- Identifies co-payment procedures and fiscal procedures related to registration procedures.
- Completes computer and telephone pre-registrations to maintain patient flow.
- Coordinates patient placements based on patient condition, physician orders, continuum of care needs, and room availability with nursing services.
- Utilizes correct financial class, payer codes, patient types, hospital service, admission source, and Medicare codes.
- Provides backup support to Emergency Room Registration as needed.
- Enters insurance policy number, group number, address, and telephone numbers.
- Identifies co-payment and follows collection procedure.
Patient Financial Counselor
- Processes patient applications for financial assistance, charity, HCL, and bank loans.
- Manages patient accounts to include service(s) reconciliation & return accounts.
- Coordinates payment arrangements.
- Processes returned mail.
- Communicates with patients/customers taking phone calls and in person.
- Provides back up support for “in-house” verifications and cashier window.
- Re-bills claims when applicable.
- Processes medical records requests.
- Assists in other financial reimbursement duties as they are assigned.
- Utilizes reporting queues and work lists to complete reimbursement collections and classifications.
Cashier
- Posts payments and reconciles general ledger accounts.
- Manages Petty cash funds.
- Refers patient to financial counseling, when necessary, and performs some financial counseling duties.
- Secures patient valuables.
- Maintains death book.
- Registers employees for activities and manages accountsCentral Scheduling<./ul>
Central Scheduling
Insurance Verifier
- Verification of commercial insurance, Medicare, Medicaid, and Worker’s Compensation on inpatient and outpatients for accounts greater than $500.00 using multiple applications.
- Organizes and prioritizes work queues.
- Obtains payer pre-certification for scheduled appointment and reworks accounts for payer denials.
Scheduler
- Schedules appointments as requested by physician offices.
- Provides patient preparation information to families and patients.
- Processes all incoming orders using the scheduling software .
- Coordinates resolution of incomplete or inaccurate physician orders.
- Organizes confirmed orders.
- Answers telephone calls.
- Documents, files, and delivers physician orders to servicing departments.
Pre-Registration
- Pre-registers scheduled and non-scheduled procedures and cases.
- Identifies co-pay amounts at the time of pre-registration using various applications and materials.
Home Health Care and Hospice
NOTE: Sections 1.0 and 2.0 are not applicable to the Home Health Care/Hospice Patient Financial Services Representatives. Section 3.0 is generally applicable.
- Conducts billing cycle process.
- Assists with inventory control.
- Enters accounts receivables.
- Ensures timely turnaround on accounts receivables.
- Interacts with the billing component of the Horizon Home Care System.br>
Physical Therapy/Occupational Therapy
Patient Eligibility and Benefit Status
- Checks next day schedule to determine insurance and pre-cert status of all incoming patients.
- Re-checks status of each Medicaid patient at each visit and updates accounts as changes arise.
- Assists department secretary with questions related to registration.
- Verifies insurance eligibility and benefit status of patients after registration.
- Troubleshoots roadblocks to reimbursement and keeps up with Medicare/Medicaid website bulletins.
- Contacts appropriate insurance entity to determine needs and requirements for pre-certification.
- Provides copies of initial evaluations, scripts and progress reports to pre-certing agencies including commercial insurance or Medicaid agencies as needed to receive authorization for treatment.
- Provides Visit Tally sheets to each patient chart to assist therapists in tracking visits and time allotments.
- Scans all authorization records in HPF.
- Maintains each parent account updated as visits are approved.
- Assists Patients and Therapists.
- Responds to all incoming insurance/billing questions.
- Assists patients with billing questions on an individual basis.
- Assists therapists with insurance questions and number of visits allowed.
- Notifies patients when authorizations are completed either by a telephone call or written communication.
- Chairs Patient Satisfaction “Strive for Five” Committee and supplies all surveys to therapists for review.
- Monitors review process.
- Assists with typing needs of therapists.
- Assists coordinators with typing schedules and computer questions.
- Works Patient Denials.
- Works Caremedic accounts as needed to assist CBO with denials.
- Obtains retro authorizations for patients as required.
- Provides Notary services as requested.
- Provides education to therapists regarding documentation necessary for optimal reimbursement.
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| Qualifications: | Intermediate computer knowledge and skills including Microsoft Office.
Knowledge of insurance, Medicare and Medicaid processes.
Excellent written and verbal communication skills.
Ability to work with diverse groups including physicians, therapists, patients, and families.
Minimum Position Qualifications
High school diploma or equivalent required
Prior experience in a Hospital/Physician Office related position is preferred
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