Patient Accounts Rep

Summary

Under the general supervision of the Supervisor, but according to established policies and procedures, interviews, pre-registers and admits patients. Finances patient accounts for Admission and other Ambulatory Departments by collecting 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 prior hospital services, requests cash deposits by approximating charges for scheduled services or co‑payments or co‑insurance if applicable.

Arranges payment agreements and contacts the Patient Financial Advocates when necessary, making preliminary determinations on welfare eligibility and/or RIH Financial Assistance program. Verifies all demographic and insurance information, obtains and/or applies for referrals or authorizations from payers as required by hospital policies. Brown University Health employees are expected to role‑model the organization’s values of compassion, accountability, respect, and excellence, and to demonstrate the core success factors of instilling trust, valuing differences, focusing on patient and community, and collaborating.

• Interview patients or patient representatives to obtain complete and accurate personal and financial information.
• Follow up on missing data by contacting patients, families, employers, nursing homes and other facilities.
• Utilize multiple systems to validate the accuracy of a patient’s health insurance, obtain authorizations and determine patient liability.
• Contact patients/families to complete pre‑admission demographic and financial information including copays, deductibles, co‑insurance and outstanding balances.
• Complete Medicare Secondary Questionnaire, liability information, etc., when applicable.
• Mail Welcome Brochure to patients.
• Validate patient insurance using Passport Eligibility System, phone calls to insurers or payer websites.
• Obtain authorizations for inpatients, observation and selected outpatients.
• Contact patients and physicians if a payer denies authorization approval.
• Review outpatient/observation pre‑admission Medicare patients to ensure appropriate patient class per Medicare status “C” regulation.
• Follow up with physicians as applicable.
• Advance Beneficiary Notice (ABN) validates for selected outpatient services for Medicare patients, ensuring coverage.
• Work with physicians’ offices to ensure accuracy of selected procedures.
• In‑house patients: obtain appropriate authorizations for patient class changes, visit patients on the nursing unit to explain financial responsibility changes.
• Follow up on all missing information and unsigned documents for ED admissions by visiting patients on the nursing unit.
• Meet with patients/families when Medicare patients have used all inpatient coverage days to decide on using Lifetime Reserve Days; arrange payment if not used.
• Daily in‑house patients with RI Medicaid or Mass Health validate managed‑care product and obtain authorization.
• All in‑house patients validate insurance the first of each month.
• Complete pre‑admission testing registration, including necessary demographic and financial information, welcome booklet and Advanced Directives.
• Complete pre‑admission registration.
• Direct admissions are completed on the nursing unit by the Patient Account Representative.
• Self‑pay patients: refer to Medicaid Specialist/Patient Financial Advocate.
• Complete waiver for “Non‑Covered Services” for non‑Medicare payers and “No authorization at time of service” for non‑Medicare payers.
• Coordinate daily admission reports for payers.
• Greet and direct all patients, families and visitors promptly and courteously.
• Verify identification (license, etc.), take patient photo, and obtain patient agreement signatures.
• Explain Patient Consent and Patient Agreement, obtain required signatures, and meet hospital policies.
• Obtain any missing demographic or financial information.
• Review Passport Eligibility responses to ensure insurance validity.
• Provide and review with the patient or designee HIPAA Privacy Notice, Ethics brochures, Patient Rights, Hospital…