Patient Access Representative

Under the general supervision of the Patient Access Director, this position performs imperative duties including but not limited to appointment scheduling, registration, insurance verification, telephone coverage, patient collections, registration follow up, and customer service. Acts a trainer and/or subject matter expert for team.

 

Required to be available for standby.

Scheduled to work in Truckee and IVCH facilities as needed. 

 

• Registers patients by verifying identity and interviewing patient or representative in a pleasant, professional, and timely manner according to department practices.
• Ensures all necessary demographic and financial data is obtained and accurately entered into the electronic health record (EHR).
• Scans all necessary insurance information, including insurance cards, personal identification, driver’s license, physician order, etc. into EHR.
• Validates existing data related to prior registrations by asking patient to repeat all data and updating appropriately in the EHR.
• Identifies appropriate payor sources and verifies eligibility according to department procedure for all patients.
• Checks to ensure authorization has been obtained prior to services being rendered. If authorization is not in place, follows Financial Clearance policy. Creates and discusses Intent to Proceed with a Non-Authorized Service forms as needed. Scans all appropriate documentation into the EHR.
• Refers all private pay and underinsured patients to the Financial Counselors or Eligibility Advocate.
• Initiates patient financial conversations with respect and privacy. Creates estimates for services and delivers to patient. Collects estimated amount due per TFH Financial Clearance Policy. Documents all estimates, conversations, and collections in EMR. 
• Understands and can explain hospital payment options to patients.
• Holds sufficient understanding of insurance protocols for orders, authorizations, referrals, co-payments, deductibles, allowed amounts, etc.  
• Maintains and updates knowledge regarding all types of insurance and healthcare coverage, utilizing reference materials provided, when necessary.
• Understands and follows all regulatory requirements including but not limited to: Emergency Medical Treatment and Labor Act (EMTALA), Health Insurance Portability and Accountability (HIPAA), and Red Flag Rules.
• Performs alternate provider workflow for not on staff providers including, NPI check and OIG Exclusion List checks. Documents all information in EHR.
• Informs patients of and obtains signatures timely for all registration forms including but not limited to: Conditions of Admission, Guide to Billing and Financial Assistance, Patient Rights and Responsibilities, Notice of Privacy Practices, Acknowledgment of Patient Information on Advance Directives,  Important Message from Medicare, and California Observation Notice.
• Possesses knowledge of and can explain all forms, required registration information, and procedures as needed.
• Creates armbands, labels and other documentation as necessary. Places armbands on patients following appropriate policy and procedure.
• Obtains worker’s compensation accident information when applicable. Calls patient employer to verify employment. Obtains all insurance information from employer timely. Contacts insurance company to gather claim information. Enters all information into EHR.
• Performs cashier functions for all patients who present cash, check or credit card as payment for services. Requests, processes, and deposits all payments per department cash handling policy to promote stewardship of District resources.
• Completes Medicare Secondary Payor Questionnaire and documents responses in EHR.
• Uses EMR to check local coverage determinations for Medicare patients as needed. Generates and produces Advanced Beneficiary Notices (ABN’s). Delivers to patients and documents in EMR.
• Assists patients with filling out medical records release forms. Verifies patient identity and documents on forms. Sends all Release of Information (ROI) forms to Health Information Management (HIM).
• Schedules patients for walk-in services. Assists in scheduling patients at check out.
• Utilizes patient schedules to prepare for patient appointments when possible including but not limited to: missing re