Patient Access Representative

Reports to the Department's Designee. Follows established 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 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.

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.

• Interviewing patients for pre-admission or upon presentation for admission in the registration or designated area.
• Promptly works alerts through the Teletracking 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 financial system.
• Audits each account for demographic errors by using Financial Clearance Workstation (FCW).
• Updating the system after validation of the new patients 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 patients 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 the pre-registration process or when the patient presents for service in accordance with 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 dashboard to verify insurance is eligible and correct.
• Verify network eligibility for potential transfers for Transfer Direct.
• Obtaining VOB information from the insurance company, such as: co-payment, co-insurance, deductible, the amount of the deductible that has been met year-to-date, family deductible, maximum out-of-pocket limit and rehabilitation benefits.
• Obtaining pre-certification information from the insurance company's pre-certification unit (i.e., whether pre-certification is required, if the ordering physician has completed it, etc.).
• When the ordering physician has not completed the pre-certification, calling the physician's office to initiate the pre-certification process and following up until it has been completed.
• When the ordering physician has completed the pre-certification, documenting the authorization and releasing the account.

• Preparing patient statistics (i.e., percentages) regarding completed demographic information as requested by the Department Designee.
• Processes…