Senior Patient Access Representative

Employment Type:

Full time Shift:

Day Shift
Description: POSITION PURPOSE

Serves as a highly skilled colleague that performs outpatient and inpatient registrations including financial clearance tasks and functions. Collects patient financial liability payments, provides general information to hospital users, patients, families, and physician offices. Ensures that patients meet financial requirements including Medicare medical necessity, payer pre-certifications and referrals. Provides excellent patient focused customer service and communicates effectively to service delivery areas to maximize patient flow and customer service. The Patient Access Representative Sr (PAR Sr) is cross trained in all areas of department including Bed Desk and assists in the onsite onboarding and mentoring of new hires.

ESSENTIAL FUNCTIONS

1. Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.

2. Greets patients upon their arrival and enters patient into patient tracking system; distributes patient information according to hospital policy and compliance regulations. Obtains State issued photo ID.

3. Identifies and selects the correct medical record number for patients already listed in the hospital database (master patient index) or creates a new medical record number for unlisted/new patients.

4. Validates and enters patient demographic information and primary care physician information into the hospital information system.

5. Reviews information for accuracy.

6. Understand the requirements of various insurance payers including capitation services and obtains insurance referrals, insurance forms, patient financial responsibility forms, and insurance cards. Maintains knowledge of insurance requirements communicated by email, memorandum, educational opportunities, and in-services. Verifies patient insurance and eligibility/benefits at registration, at patient type change and when required.
7. Verifies physician scripts for completion and according to policy following up as needed for invalid or incomplete scripts including converting ED registration level of care/status changes to inpatient or observation.

8. Understands the basics of coding diagnoses and procedures as required for insurance authorizations and Medicare compliance. Utilizes online program for Medicare compliance, checking for diagnosis codes that correlate to testing ordered by physician. Obtains consents for Advance Beneficiary Notices (ABN) when required by Medicare.

9. Utilizes system generated Work Alerts and Work Queues to identify any omissions or errors. Resolves all identified omissions and / or errors within 72 hours of admission.

10. Collects self-pay deposits, co-payments, and deductibles from patients. Identifies any outstanding prior balances from previous visits, notifies patients during financial discussion and requests payment.

11. Posts all patient payments into hospital system, provides patient/family member with receipt. Follows department / hospital policies and procedures for handling and safeguarding monies and reconciles all point of service payments at end of shift and deposits with Cashier.

12. Assists and provides information to patients or guarantors on Financial Assistance. Refers to financial counseling as needed. Distributes information on the No Surprises Act according to policy.

13. Explains and obtains legal signatures from the patient or legal guardian on consents for treatment, level of care/status change as required by Federal and State law and payments.
14. Assures Admission or Observation paperwork is available and transported to the correct Nursing Unit per policy.

15. Scans all consents, cards, scripts into document imaging system.

16. Bands patient with wristband as per department policy.

17. Coordinates with the Clinical Team as necessary to assure patient safety and efficient service delivery.

18. Provides flexibility to serve in any outpatient registration area that requires additional support to maximize patient flow and excellence in customer service.

19. Understands downtime and disaster protocols and when necessary, implements and utilizes organizational and departmental procedures.

20. Manages time effectively to perform complete registrations while meeting departmental productivity standards in compliance with system productivity policies.

21. Maintains high attention to detail by reviewing all work for completeness and accuracy in compliance with system quality assurance policies. Completes registrations to meet department accuracy standards for error-free work.
22. Participates and completes all assigned educational and skills development activities as assigned.

23. Participates in department or individual performance improvement initiatives as assigned or directed by manager.

24. Participates in necessary day-to-day tasks aimed at ensuring departmental metric performance.

25. Escalates any patient complaints or patient safety issues and/or patient financial concerns to Manager in a prompt manner

26. Assists in the onsite onboarding of new hires.

27. Performs duties related to quality assurance such as generating, reviewing, and reporting out registration reports and findings to management.

28. Cross-trained to work in and supports the registration or processing of patients in other Patient Access areas as needed.

29. Must possess the ability to comply with Trinity Health policies and procedures. Must be comfortable operating in a collaborative, shared leadership environment.

30. Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health's Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

31. Other duties as needed and assigned by the manager.

BED DESK ESSENTIAL FUNCTIONS

May be assigned to work at Bed Desk to perform Bed Assignments, Direct Admissions and Transfers, Hospice Admissions, and Census Reconciliation.

BED ASSIGNMENTS:

• Expedites the assignment of patient beds according to physician order and coordinates bed assignment in alignment with nursing unit specialization.

• Validates physician order matches with system.

• Follows all Infection Control policies and procedures with regards to patient room assignments.

• Coordinates with Nursing as needed for advance clinical directions regarding room assignments.

• In coordination with the insurance verification department, the Bed Desk registrar will obtain necessary pre-authorizations and / or Notice of Admission from payers to fulfill payer requirements for patient level of care changes.

DIRECT ADMISSIONS AND TRANSFERS IN:

• Receives, documents, and pre-registers physician requests for Direct Admissions and Hospital Transfers In.

• Validates demographics and verifies insurance for all Direct Admission requests.

• Obtains admission authorizations from transferring facility and / or payer and validates with Case Management on level of care approvals.

• Readies admission paperwork and communicates with patient or transferring facility on admission date/time based on bed availability.

HOSPICE ADMISSIONS:

• Receives, documents, and promptly pre-registers physician requests for Hospice Admission.

• Validates demographics and verifies insurance for all Hospice requests.

• Readies Hospice admission paperwork and communicates with patient or patient representative on admission date/time based on bed availability.

MINIMUM QUALIFICATIONS

1. High school diploma or an equivalent combination of education and experience. Minimum of three (3) years' experience of patient access functions working within a hospital or clinic environment. Experience in a complex, multi-site environment preferred.

2. HFMA CRCR or NAHAM CHAA required within one (1) year of hire.

3. Minimum of three (3) years' hospital registration experience.

4. Medical terminology and knowledge of diagnostic and procedural coding.

5. Insurance verification with the ability to explain benefits, secure necessary authorizations.

6. Effective written and verbal communication skills.

7. Ability to multi-task, prioritize needs to meet required timelines.

8. Customer service experience.

9. Strong clerical and computer skills.

10. Basic understanding of Microsoft Office, including Outlook, Word, PowerPoint, and Excel.

11. Excellent interpersonal skills are necessary in dealing with peers, internal and external customers.

12. Accuracy, attentiveness to detail and time management skills.

13. Willingness to learn other registration related tasks and functions in or outside of their hired team to ensure operational demands are met

14. Cross-trained in either scheduling, final financial clearance (insurance verification) and / or financial counseling.

15. Must be comfortable operating in a collaborative, shared leadership environment

16. Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS
1. Must possess the ability to comply with Trinity Health policies and procedures.

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