Patient Access Rep I COND Full Time

Department:

10247 Revenue Cycle - Outpatient/Admit: Condell

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

Week 1 = Monday-Friday 0700-1530

Week 2 = Monday, Wed-Friday 0700-1530, Saturday 0630-1500

Major Responsibilities:

• Accurately collects and analyzes all required demographic, insurance/financial, and clinical data necessary to register/admit patients from all payer classes.
  •     1)Recognizes communication obstacles for patients with loss of hearing and/or sight, and those that have trouble in reading, writing and understanding the English language. Responds appropriately to patients' communication needs, secures interpreter or other necessary assistance to ensure customer comprehension.
  •     2)Using approved identification standards, positively identifies the patient and ensures assignment of a unique medical record number and appropriate banding.
  •     3)Collects and records accurate and thorough patient, guarantor, insured and insurance information when registering patients' accounts.
  •     4)Interprets and validates physician orders for service, uses appropriate accommodation and service codes; and establishes account parameters to ensure revenue is properly recorded and accurate bills are produced.
  •     5)Using insurance eligibility software, validates demographic information and assures patients are eligible for service provided.
  •     6)Appropriately explains, secures, and witnesses all signatures required to provide medical treatment, assign insurance benefits, release information, establish financial responsibility and meet other internal regulatory, or payer requirements.
  •     7)Completes the Medicare Questionnaire for all Medicare patients, ensures inpatients receive the important Medicare Message document.
  •     8)Understands and follows all government, managed care and commercial insurance plan rules as they relate to patient access; and ensures accounts are in order for timely billing and collection.
  •     9)Accurately generates, assembles and processes all required forms, documents and reports including face sheets, labels, and wristbands, medical record forms, and other special documents. Produces and distributes these on a timely basis to both internal and external parties.
  •     10)Analyzes and records data and processes transactions to ensure that an accurate historical patient data base is maintained for each registration encounter.
• Performs revenue cycle activities that prevent payment denials, increase cash collections and assures appropriate financial disposition of account balances.
  •     1)Initiates electronic and/or telephone inquires to insurance payers/claim administrators. Provides information and secures responses that confirm eligibility for the third-party benefits and the level of benefits available.
  •     2)Identifies and obtains needed authorizations, referrals and service approvals from physicians, insurance companies and/or medical management companies.
  •     3)Explains to patients their insurance benefits, self pay balances and provides information to ensure they understand the policies that govern the revenue cycle and the processes that will be followed.
  •     4)Explains various payment options to the patient or responsible party and negotiates acceptable resolution of expected self pay balances.
  •     5)Explains the charity care process and provides application packet. Updates system to record charity application was given to patient/responsible party.
  •     6)Using compliance checker software, screens physician orders against medical necessity criteria. Follows procedures related to obtaining additional diagnosis from physicians and initiating the Medicare Advance Beneficiary Notice of Non-Coverage to patients.
  •     7)Reviews and analyzes records of active patients to identify and resolve situations where future care is different than originally identified, including re-verification of insurance coverage, recertification of payer requirements, and recalculation of patient l