Patient Access Rep; BGH

Overview

Reports to the Registration Manager or the Registration Supervisor. Follows established Memorial Hospital of South Bend (MHSB)/Beacon Granger Hospital (BGH) policies and procedures to admit and register patients for services in a professional and courteous manner. Is responsible for accurate and complete registration of all MHSB/BGH patients. Must maintain regulatory and functional knowledge of all information required which ensures timely and accurate reporting/billing.

Collects applicable co-payments and deductibles and completes insurance verification and must be able to accurately decipher eligibility responses and relay that information back to the patient. Performs daily cash balancing procedures. Obtains all required signatures on paperwork and performs clerical duties as necessary.

• MISSION:
  We deliver outstanding care, inspire health, and connect with heart.
• VALUES:
  Trust. Respect. Integrity. Compassion.
• SERVICE GOALS:
  Personally connect. Keep everyone informed. Be on their team.

• Registers Patients (in order to obtain demographic, physician and insurance information in accordance with established departmental policies and procedures) and collects applicable co-payments and deductibles by
  
  • Interviewing patients via telephone for pre-admission or upon presentation for admission in the registration area.
  
  • Promptly works alerts through the Tele-tracking system by creating an account for all direct admits, transfers, and add-on procedures.
  
  • Obtaining identification, demographic, physician and insurance information from patients and accurately entering this information into the Hospital financial system.
  
  • Audits each account for demographic errors by using Financial Clearance Workstation (FCW).
  
  • Updating the system after validation of the new patient’s financial information.
  
  • Using the Pathways Healthcare Scheduling (PHS) or Cerner databases to locate/retrieve scheduled patients for admission/registration input into STAR.
  
  • Generating PHS and Surgi Net reports to facilitate pre-registration.
  
  • Explaining about the possible need to pre-certify with the patient’s insurance carrier in order to ensure maximum coverage to the limits of the insured’s insurance policy.
  
  • Verifying and documenting insurance coverage via online eligibility systems, internet resources or via telephone.
  
  • Requesting copies of the insurance card(s) and driver’s license or other government picture  confirm insurance benefits and identification.
  
  • Providing the Medicare letter for Medicare patients; also completing the Medicare Secondary Payor Questionnaire (MSP) and Advance Beneficiary Notice (ABN).
  
  • Validating medical necessity via the MCA Compliance Checker where applicable.
  
  • Completing the MSP (Medicare Secondary Payor) questionnaire by asking the patient the questions based on patient availability.
  
  • Requesting payment either during the pre-registration process or when the patient presents for service in accordance with MHSB/BGH policies and procedures.
  
  • After collecting applicable co-payments and deductibles, posting patient payments (including cash, checks and credit cards) on the patient’s account and generating a system receipt to give to the patient.
  
  • Maintaining a cash drawer in order to make the appropriate change for patients making payment at the time of service; also responsible for balancing and reconciling the cash drawer at the end of the shift.
  
  • Referring the patient to the Financial Counselors or Eligibility Specialists if they are unable to secure satisfactory payment arrangements and have a self-pay balance of $500 or more. Also assisting in obtaining additional patient information, copies of insurance card(s) and church information.
  
  • Obtaining all required signatures for the ‘consent to treat’ and assignment of insurance benefits forms.

• Verifying insurance coverage and network status by using online eligibility systems and websites to determine the patient’s benefits under the insurance plan.
  
  • Audit insurance eligibility by using the Relay Connect…