PATIENT ACCESS REPRESENTATIVE- PRN

Summary/Objective: Patient Access Representative (PAR) is the first line of exceptional customer service patients and providers experience at Sweeny Community Hospital (SCH). The PAR will be tasked with registration, scheduling, insurance verification, authorizations, patient responsibility estimates, order reconciliation, scanning, and directing patients as needed.

Essential Functions:

• Communication
• Registration, Scheduling and Pre-authorization
• Financial

Communication:

1. Answers calls in a prompt, professional and courteous manner; addressing the caller’s needs, unless beyond their scope of knowledge; transfers calls or takes messages when appropriate.
2. Checks messages and hospital email timely, at least morning/noon/end-of-day and takes immediate action.
3. Greets those presenting to Registration, ascertains needs and take appropriate action.
4. Overhead paging, code/trauma paging, drills and monitors EMS radio ER traffic (OP or ED specific)
5. Places calls when required to assist healthcare team with facility to facility transfers or notifying authorities.
6. Communicates promptly with patient, family members, physician, and clinical department if delays are anticipated/encountered.

Registration, Scheduling, and Pre-Authorization:

1. Accurately and efficiently pre-registers, quick registers or registers patients for services
2. Follows established procedures to obtain and confirm patient demographic, ID, and insurance information for every visit.
3. Follows established procedure to obtain and confirm insurance eligibility & benefits at every visit.
4. Obtains patient or designee signature on all required consents/forms.
5. Follows established procedure for scanning & data housing of insurance, identification cards and consents.
6. Follows established procedures to obtain required authorizations prior to procedures or inpatient/observation stays.  Communicates scheduled events & appropriate pre-test information to patient/family member, as necessary.  Provides reminder call ahead of scheduled outpatient testing.
7. Completes Medical Necessity reviews as required and notifies ordering physician if codes fail Medical Necessity.  Issues and explains Advanced Beneficiary Notifications to patient/family member as required, ensuring CMS compliance
8. Maintains accurate physician/provider orders in compliance with established guidelines by HIM.  Takes appropriate action if orders are expired or incomplete.
9. Follows established protocol for post-registration action related to patient’s care.
10. Completes Admission Packets and Medicare IM for Medicare Inpatients and MOON forms those OBS Patients
11. Maintains current knowledge base for insurance changes, updates, and processes as they apply to patient access.

Financial:

1. Notifies patient of estimated patient responsibility for services at time of scheduling.  Collects deductibles, co-pays, co-insurances, or self-patient responsibility at that time.  Discusses and executes financial options with patients prior to scheduling outpatient elective procedures.
2. Collects patient responsibility after initial evaluation in ER or at time of services
3. Refers patients to the Care Program Coordinator when appropriate
4. Receives, processes, and post patient payments and non-patient purchases and provides receipts
5. Follows established procedure to balance cash drawer at beginning and end of shift.
6. Places change request to maintain par-levels of bills and coins to meet daily treasury needs in the hospital. Reports variances immediately to supervisor and aids in resolution.

Competencies:

Communication proficiency

Understanding and compliance to HIPAA and EMTALA rules

Ethical Conduct

Flexibility

Teamwork

Problem Solving

Supervisory Responsibility:

This position has no supervisory responsibilities.

Work Environment:

This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, fax machines, and other equipment as needed. Requires professional relationships with patients/clients and their family members, Patient Financial Services personnel, physicians’ office personnel, and hospital personnel. This job may require exposure to communicable diseases.

Physical Demands:

The employee is occasionally required to stoop, bend, turn, stretch, kneel, or crouch. Must be able to lift and/or move up to 10 pounds, push and pull. Good visual and hearing acuity, able to sit for long periods of time. While performing the duties of this job, the employee is regularly required to talk and hear.  Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

Position Type/Expected Hours of Work:

Unless noted in the job posting, this is a full-time position.

Position requires flexibility based on needs of the facility and as requested by the supervisor.

Outpatient Services:

Monday thru Thursday, 7am-7pm

Friday, 7am-4pm

Emergency Department:

24/7 – including weekends & holidays

TRAVEL:

Representative is expected to have dependable transportation.

Required Education, Experience and License:

High School Diploma or equivalent.

Basic knowledge of data collection, and healthcare insurance

Experience in customer service

Preferred Education, Experience and License:

At least 2 years of experience in healthcare patient registration and customer service is preferred.

Associates degree from accredited College/University or 3 years’ experience in place of degree

Additional Eligibility Qualifications:

Able to multi-task

Basic Microsoft Office applications, keyboarding, 10-key by touch.

Demonstrate effective verbal, written and telephone communication skills.

Must be able to handle stressful situations and people in a calm and efficient manner.

Excellent public relations as well as behaving in a professional, mature and respectful manner at all times.

Possess effective time management, organization and situation awareness skills in a fast paced environment.

Work Authorization/Security Clearance (if applicable):

AAP/EEO Statement:

Sweeny Community Hospital provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics.

Other Duties:

1. Provides back-up support to Care Program Coordinator
2. Process USPS flat rate shipping hospital.  Logs expenditures for monthly reconciliation
3. Maintains and orders office supplies for PFS work areas.
4. Following established protocols maintains communication/documentation logs.  May include but not limited to:   Trauma, EMS Transfer, Physicians, Ancillary/General call, Interpretation sign out, and Key Checkout,
5. Follows established procedure to prepare Midnight Patient Census and stocks physician/nursing t-sheets (Night shift only)
6. Maintain cleanliness of lobby when environmental services team member is unavailable
7. May be trained on additional aspects of the Revenue Cycle activities
8. Position may be cross trained for registration duties in other work units.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for their job.