Patient Access Rep - PRN Emergency; 1st Shift

Department: 10256 Enterprise Revenue Cycle - Condell IL ED Arrival

Status: Part time

Benefits Eligible: No

Hours Per Week: 0

Schedule Details/Additional Information:

• PRN/As needed position
• Must pick up at least 35 hours per month with one of the shifts being on a Saturday or Sunday and one holiday per year per the PRN contract in order to keep PRN status

Pay Range $20.40 - $30.60

• Accurately collects and analyzes all required demographic, insurance/financial, and clinical data necessary to register/admit patients from all payer classes.
  • 1) Recognizes communication obstacles for patients with loss of hearing and/or sight, and those that have trouble in reading, writing and understanding the English language. Responds appropriately to patients' communication needs, secures interpreter or other necessary assistance to ensure customer comprehension.
  • 2) Using approved identification standards, positively identifies the patient and ensures assignment of a unique medical record number and appropriate banding.
  • 3) Collects and records accurate and thorough patient, guarantor, insured and insurance information when registering patients' accounts.
  • 4) Interprets and validates physician orders for service, uses appropriate accommodation and service codes; and establishes account parameters to ensure revenue is properly recorded and accurate bills are produced.
  • 5) Using insurance eligibility software, validates demographic information and assures patients are eligible for service provided.
  • 6) Appropriately explains, secures, and witnesses all signatures required to provide medical treatment, assign insurance benefits, release information, establish financial responsibility and meet other internal regulatory, or payer requirements.
  • 7) Completes the Medicare Questionnaire for all Medicare patients, ensures inpatients receive the important Medicare Message document.
  • 8) Understands and follows all government, managed care and commercial insurance plan rules as they relate to patient access; and ensures accounts are in order for timely billing and collection.
  • 9) Accurately generates, assembles and processes all required forms, documents and reports including face sheets, labels, and wristbands, medical record forms, and other special documents. Produces and distributes these on a timely basis to both internal and external parties.
  • 10) Analyzes and records data and processes transactions to ensure that an accurate historical patient data base is maintained for each registration encounter.
• Performs revenue cycle activities that prevent payment denials, increase cash collections and assures appropriate financial disposition of account balances.
  • 1) Initiates electronic and/or telephone inquires to insurance payers/claim administrators. Provides information and secures responses that confirm eligibility for the third‑party benefits and the level of benefits available.
  • 2) Identifies and obtains needed authorizations, referrals and service approvals from physicians, insurance companies and/or medical management companies.
  • 3) Explains to patients their insurance benefits, self pay balances and provides information to ensure they understand the policies that govern the revenue cycle and the processes that will be followed.
  • 4) Explains various payment options to the patient or responsible party and negotiates acceptable resolution of expected self pay balances.
  • 5) Explains the charity care process and provides application packet. Updates system to record charity application was given to patient/responsible party.
  • 6) Using compliance checker software, screens physician orders against medical necessity criteria. Follows procedures related to obtaining additional diagnosis from physicians and initiating the Medicare Advance Beneficiary Notice of Non‑Coverage to patients.
  • 7) Reviews and analyzes records of active patients to identify and resolve situations where future care is different than originally identified, including re‑verification of insurance coverage, recertification of payer requirements, and recalculation of patient liabilities.
  • 8) Requests and accepts payments, generates receipts for funds received and maintains necessary records of payment transactions. Utilizes automated systems to process credit and debit card transactions.
  • 9) Ensures payments are secured; and deposits and cash drawers are balanced and turned over to appropriate associates.
• Performs department general clerical and support duties.
  • 1) Receives, properly responds to, or redirects telephone, electronic, and in-person inquiries from patients, payers, physician and their staff, internal departments, external organizations and other persons or entities. Obtains, receives and documents accurate and thorough information when taking messages.
  • 2) Accurately records and ensures patients are entered into the patient tracking systems. Takes action to ensure patient waiting and turnaround time is not excessive and meets department goals. Notifies Coordinators/Manager or…