Patient Access Representative

Job Summary

The Patient Access Representative I is a unique role within the Kaiser Permanente Health System environment. The Patient Access Representative I welcomes the patient into the care delivery setting and initiates the administrative systems that will lay the groundwork for the patients clinical care as well as the financial documentation. The Patient Access Representative I is responsible for ensuring a complete and accurate Patient admission/registration.

Responsibilities include but are not limited to: collecting pertinent registration data, performing functions such as limited insurance eligibility and benefits verification, point of service cash collection, based on established manual or technological protocols, and completion of documentation necessary for the expedient registration/ admission of Patients according to organizational policy and procedures and federal/state/regulatory requirements. Obtaining inpatient bed assignments and processes inpatient admission, including direct admit, to include following patient identification protocols and completion of necessary documentation.

Refers patients to Financial Counselors for Medical Financial Assistance. Answers and/or refers questions received from patients, visitors, staff as appropriate. Performs various related cash handling procedures per SOX control regulations. This position acts as an ambassador to ensure a patient friendly experience. The Patient Access Representative I has knowledge of state and federal regulations governing patient healthcare encounters and assures compliance.

The Patient Access Representative I facilitates the patient and family care experience and aids them in understanding the Kaiser Permanente Healthcare System facilities and routines. The Patient Access Representative I works closely with both the financial team (Patient Business Services and the payor(s)) and the clinical team (nursing, physicians, hospital supervisors, etc) to ensure the optimum patient experience, accurate registration, maximum cash flow and reimbursements for the system.

This position is an intermediate level position that requires a professional service-oriented individual with strong organizational skills working under limited supervision. The work environment at times can be stressful, pressured, or hostile. This position works on the front line with constant patient interaction in high volume registration areas and the Emergency Departments. Work situations are varied and require an individual with the ability to respond to patients and families with compassion, respect, and understanding.

This position requires strong organization skills, prioritization, good judgment, diplomacy, and independent thinking. Internal contacts include physicians, staff and management throughout the organization, including, but not limited to, Patient Business Services, Patient Access Representative II and III, Utilization Management, Patient Flow Coordinators/HAS, and Health Information Management. External contacts include patients, families, community physicians, and outside organizations such as representatives from government agencies and allied hospitals.

Independent decision-making is required in daily routine functions. Major decisions are subject to review and approval. Staff members in this position may perform all, or a combination of the duties described depending upon their assigned work area and the specific needs of the department.

• Registration:
  Greets and registers patients for various medical services in the hospital setting potentially in a 24 hour, 7 day a week environment and in a highly active fast paced setting such as the Emergency department. Pre-registers patients where applicable. Completes comprehensive bedside or telephone interviews with Patient, relative, or their representative to obtain pertinent demographic information, insurance data and/or third party liability information.
  
  Performs minimal eligibility verification and resolves discrepancies as able or defers to appropriate resource, identifies need for financial assistance recommendation and application, referring to the…