Patient Accounts Rep

SUMMARY

Under the general supervision of the Supervisor, following established policies and procedures, interviews, pre-registers and admits patients. Financially clears accounts for Admission and other Ambulatory Departments by obtaining demographic, third-party insurance and related financial information, using Life Chart. Initiates, reviews and follows up on patient accounts to ensure proper data collection for billing, reviews any existing account balances for previous hospital services, requests cash deposit by approximating charges for scheduled services or co-payments or co‑insurance if applicable.

Arranges payment agreement and contacts the Patient Financial Advocates when applicable and makes preliminary determination on welfare eligibility and/or RIH Financial Assistance program. Verifies all demographic and insurance information and obtains and/or applies for the referrals and/or authorizations from the payers as required by Hospital policies. Brown University Health employees are expected to successfully role model the organization’s values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.

• Interviews patients or patient representatives in order to obtain complete and accurate personal and financial patient information; follows up on missing data by interviewing patients, families or calling employers, nursing homes and other facilities.
• Utilizes multiple systems to validate the accuracy of patient’s health insurance, acquire authorization and patient’s financial liability.
• Contacts patients/families to complete pre‑admission demographic and financial information including patient copays, deductibles, co‑insurance and outstanding balances. Completes Medicare Secondary Questionnaire, Liability information, etc. when applicable. Mail Welcome Brochure.
• Validates patient’s insurance using Passport eligibility system, phone calls to insurance company or payer web‑site.
• Obtains authorization for inpatients, observation and selected outpatients.
• Contact patient and physicians if payer denies authorization approval.
• Reviews outpatient/observation pre‑admission Medicare patients to ensure the patient class is appropriate following the Medicare status ‘C’ regulation. Follows up with physicians when applicable.
• ABN – Advance Beneficiary Notice validates for selected outpatient services for Medicare patients if services are covered. Works with physician’s office to ensure accuracy of selected procedures.
• In‑house patients – obtains appropriate authorization for patient class changes and visits patients on the nursing unit to explain changes in their financial responsibilities.
• Follows up on all missing information and unsigned documents for ED Admissions by visiting patients on the nursing unit.
• Meets with patients/families when Medicare patients have used all of their inpatient coverage days and can opt in or not to opt in to use their Lifetime Reserve Days. Makes payment arrangements if they choose not to use their Lifetime Reserve Days.
• Daily in‑house patients with RI Medicaid or Mass Health insurance plan validate if they have a Managed Care product and obtain the authorization.
• All in‑house patients validate their insurance the first of each month.
• Pre‑Admission testing registration – completes all necessary demographic and financial information for admission including necessary information for the admission, welcome booklet and Advanced Directives. Completes Pre‑Admission registration.
• Direct Admission is completed on the Nursing unit by the Patient Account Representative.
• Self‑pay patients – refer to Medicaid Specialist/Patient Financial Advocate.
• Completes waiver for ‘Non‑Covered Services’ for Non‑Medicare payers and No authorization at time of service for Non‑Medicare payers.
• Coordinates daily admission reports for payers.
• Greets and directs all patients, families and visitors in a prompt and courteous manner.
• Arrives Admissions: scans identification (license, etc.), takes patient photo, has patient agreement signed, explains to patient or designee the Patient Consent and/or Patient agreement and…