Senior Patient Access Representative

The Senior Patient Access Rep will report to the Patient Access Supervisor or Manager and provide patient services and administrative support in ancillary operations. Will act as a knowledge source for registration by assisting in the daily process outcomes of the department. Will support team with training and problem solving to enhance registration performance. The Sr Patient Access Rep will be responsible for the continued development of staff and work with management to develop training programs, and assist with compliance with quality assurance program. Will interact with parents, patients, physicians and other staff under moderate supervision in a courteous manner. Provide assistance to other employees within their
department as well as other departments. Collect and verify all demographic information to ensure accuracy . May provide required notification of scheduled and unscheduled services according to insurance provider requirements. May be responsible for scheduling patients for ancillary appointments. Position may be required to float to ancillary patient access areas for coverage (ED, RAD, IP , LAB, AMSAC etc.). Must be able to complete a minimum of one complex access function (Complex Scheduling , Bed Management and Complex Mentorship).

• Ensure accuracy of scheduling patients using the applicable scheduling system for the department: schedule routine and add-on exams; schedule complex radiological exams prior to the patient's arrival.

• Complete computer aided, on-line registration screen with parent/guardian via telephone or in person in professional & courteous manner. Complete bedside registration based on assigned work space.

• Collect accurate demographic and insurance information. Update systems as needed in accordance with department standards for registration accuracy: Bedside registration conducted for ED patients; Bedside registration conducted when appropriate for Inpatients.

• Update scheduling systems with cancellation and no shows by COB. Reschedule appointment for patients who did not show or for ancillary services cancellations by providers. Schedule follow up appointments at check out.

• Greet patients and parents courteously. Arrive patient in appropriate system based on department policy.

• Obtain required consents for department & ensure distribution of compliance related materials (i.e. HIPPA Privacy Notice, Patient Rights). Obtain copy of insurance card and photo ID to be stored in medical record (copy or scan activity required). Ensure applicable insurance company and CNMC HIM department receive copies of appropriate forms/documentation. Complete all documentation in accordance with department policy and procedure.

• Collect and record co-payments, deposits and payments in full and provide payer with receipt: Responsible for helping department meet 85% of the collection target for the department.

• Respond to patient portal work lists (i.e. appointment requests, fax queues, email requests, etc. May include messaging center work lists in the future).

• Verify insurance eligibility using applicable eligibility system. Ensure that managed care carve outs (lab and radiology carve outs) are adhered to. Notify insurance companies or review agency as required by hospital contract and document notification as defined by policy.

• Advise leadership of any authorization issues at the time of check-in: Identify surgeries/diagnostic testing without an authorizations; Contact provider's office or scheduling coordinator to address issue timely without delaying patient care.

• Notify parents of the need for completed insurance referral form or pre-authorization prior to scheduled/unscheduled appointment.

• Discuss co-payment, deposits, payment in full, or past due balance collections with parents in a professional & courteous manner.

• Counsel parents or refers parent to Financial Information Center (FIC) for establishing payment schedule or method of payment.

• Verify insurance information is complete prior to procedure, and collect and verify pre-authorization/referral information: Obtain authorizations 5 days in advance of service; Interface with insurance companies as needed; Document activity in "account notes" following standards set by department; Complete complex authorization process for IP services.

• Utilize all systems where patient information may be to verify that systems are in synch.

• Review and print department schedules, ensure appropriateness of scheduled appointments, and back fill open slots: For ancillary services ensure all applicable orders/scripts/referrals are obtained prior to services being rendered.

• Appropriately clear all walk-ins and ensure scheduled appointments are linked to scheduling system.

• Retrieve department chart for existing patients and prepare chart for new patients.

• Assigns beds to patients in accordance with established criteria and availability: Communicate bed assignments to sending and receiving units; Contact AD Coordinator regarding transfers from other hospitals; Process all admissions and transfer request accurately and timely; Notify insurance company of admission in a timely manner.

• Discharge active recurring accounts for patients being admitted. Follow policies and procedures for specialty discharges (i.e. WRTC).

• Reconciles charge capture against schedules.

• Maintain departmental requirements regarding cash controls and collections. Reconcile daily cash receipts/collections and submit to manager.

• Ensure that quality registration work queues are addressed timely: Activity should be completed 3-4 days in advance of ancillary session; Work standard may be 5-7 days for areas with procedures requiring authorizations.

• Provide input to manager about registration errors for ongoing training purposes: Monitor & correct registration errors; Monitor QA reports to identify training needs & ensure standards are met.

• Work with manager to reduce registration and authorization denials. Work with manager to research and resolve missing charges.

• Provide expertise to peers throughout the institution: Train & mentor PAR staff (may conduct training sessions); Provide work flow guidance.

• Answer telephone and address caller needs appropriately: Avoid transferring calls for better service to families; Meet department standards relative to ACD policies if applicable; Manage voice mail messages within same business day.

• Distribute mail. May work returned mail as needed.

• Responsible for information distributed via e-mail: Check work email a minimum of 3 times daily and respond to inquiries within 24 hours (or next business day).

• Maintain office files and office supplies at PAR levels.

• Maintain clean reception area and work space.

• Other support as needed.

• Partner in the mission and upholds the core principles of the organization

• Committed to diversity and recognizes value of cultural/ ethnic differences

• Demonstrate personal and professional integrity

• Maintain confidentiality at all times

• Anticipate and responds to customer needs; follows up until needs are met

• Demonstrate collaborative and respectful behavior

• Partner with all team members to achieve goals

• Receptive to others' ideas and opinions

• Contribute to a positive work environment

• Demonstrate flexibility and willingness to change

• Identify opportunities to improve clinical and administrative processes

• Make appropriate decisions, using sound judgment

• Use resources efficiently

• Search for less costly ways of doing things

• Speak up when team members appear to exhibit unsafe behavior or performance

• Continuously validate and verify information needed for decision making or documentation

• Stop in the face of uncertainty and takes time to resolve the situation

• Demonstrate accurate, clear and timely verbal and written communication

• Actively promote safety for patients, families, visitors and co-workers

• Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance

• Anticipate and responds to customer needs; follows up until needs are met

• Demonstrate collaborative and respectful behavior

• Partner with all team members to achieve goals

• Receptive to others' ideas and opinions

• Contribute to a positive work environment

• Demonstrate flexibility and willingness to change

• Identify opportunities to improve clinical and administrative processes

• Make appropriate decisions, using sound judgment

• Use resources efficiently

• Search for less costly ways of doing things

• Speak up when team members appear to exhibit unsafe behavior or performance

• Continuously validate and verify information needed for decision making or documentation

• Stop in the face of uncertainty and takes time to resolve the situation

• Demonstrate accurate, clear and timely verbal and written communication

• Actively promote safety for patients, families, visitors and co-workers

• Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance