Patient Access Representative

Summary:
Under the general supervision of the Supervisor and according to established policies and procedures interviews and registers all patients (Inpatient and Observation Emergency and Outpatients) to obtain demographic third party insurance and related financial information and enters to on-line computer system. Initiates reviews and follows-up on patient accounts to ensure proper data collection for billing. Verifies all demographic and insurance information and obtains referrals as required.

Responsibilities:
Greets and directs all patients families and visitors in a prompt and courteous manner.

Interviews patient or patient*s representative in order to obtain complete and accurate third party health insurance and related personal/financial information. Follows-up on missing data by interviewing patients families or calling employers nursing homes and other facilities

Completes registration and enters all data obtained into hospital computer system. Prepares or completes manual records as follows:

Ensures patient is properly identified in system per department policy. Verifies demographic and insurance information by asking open-ended questions.

Registers all patients (Outpatient ED Inpatient and Observation) by entering and/or verifying demographic insurance information into hospital information system. Upgrades account to an active account status.

Completes documentation required on financial clearance reports as indicated by Patient Advocate or Pre-Registration Office.

Utilizes on line tools and/or telephone to verify coverage determine level of benefits and confirm that the primary care physician (PCP) matches the PCP that is recorded in hospital system. Contacts insurance carrier or company for missing information when necessary. Notifies Pre-Registration Office if coverage changes from pre-admit/pre-registration information.

Identifies primary and secondary insurer. Properly records insurance information in system. Completes lien forms upon determination that a liability exists. Enter financial notes into system.

Gathers paper referrals from patients when required by the payer. Updates SMS with the appropriate documentation. Contacts Financial Counselor/Pre-Registration Office if the insurance does not verify or if the patient does not a referral when required by the payer.

Utilizes system to determine self-pay balances for all patients.

Uses reference tools to determine the expected payment due at time of service. Contacts Patient Financial Advocate to estimate expected payment on complex cases. Refers patients to Patient Financial Advocates if patients cannot meet the expected payment according to defined criteria.

Collects co-payments as required per financial clearance or as required by third party payor or department policy. This includes cash; check credit card payments for ambulatory and Emergency services or as indicated by Patient Advocates. Documents collections in system logs payments provides receipts per department policy. Completes financial clearance screens in system.

Explains consent financial and insurance forms to patients or designee and provides general hospital information regarding policy and procedure. Obtains patient signatures on all required forms to meet established hospital requirements. i.e. Privacy notice Ethics brochures Patient Rights Hospital Directory The Miriam Hospital Welcome Brochures.

Generates patient registration record and plate and distributes appropriate copies. Verifies and updates all information. Makes required plates bracelets and face sheets. Places bracelet on patients per department policies. in accordance with patient identification policy.

Utilizes hospital department scheduling and workflow reports to complete daily work. Communicates with service departments to obtain order information as required. Communicates with Financial Counselor/Pre-Registration Office to obtain authorizations not obtained at or prior to time of service

Asks patient for Advance Directive and includes with admission paperwork to go to nursing unit provides patients with information on Advance Directives if one is not prepared.

Explains and has patient sign Advance Beneficiary Notice (ABN) as required.

Completes medical necessity checks utilizing order entry system per hospital policy if not done during pre-registration process.

Distributes Payment Policy brochures when patient lacks evidence of adequate health insurance coverage according to established criteria. Refers patients to Patient Financial Advocate to assist patient with applications for medical coverage (Medicaid RIte Care etc.) or Community Free Service and to establish payment plans.

Notifies Physicians office by phone or fax of patient arrival to Emergency Department and/or admission to hospital per department policy. (ER patients only)

Upgrades Observation to Inpatient accounts per department/hospital policy when appropriate.

May pre-admit/pre-register scheduled outpatients and inpatients in hospital system.

Contacts insured patient to verify demographics obtained at time of scheduling to complete any missing information.

Verifies patient insurance coverage(s) both primary and secondary *on-line* or by telephone.

Obtains and verifies all other information require to secure payment through sources such as Worker*s Compensation MSP Medicare liability liens etc.

Ensures referrals are obtained and confirms accuracy of the PCP.

Establishes level of insurance benefits and expected payment for selected services. Determines the patient*s portion of payment when applicable and arrange for payment prior to the provision of services.

Checks outstanding balances incurred for previous services prior to contacting patient and follow collection policy concerning prepayment prior to the provision of additional services.

When appropriate medical necessity verifications for services to be provided will be performed by the servicing department and will also require that ABN*s be addressed for payment at the time of pre-registration.

May collect prepayments by phone or mail if there is enough time before admission or the provision of outpatient services to accomplish the collection otherwise instruct patient to bring payment at the time of admission/arrival.

Refers insured patients who cannot meet their financial obligations including previously incurred hospital balances current admission/outpatient expected non-covered charges and ABN*s to Patient Financial Advocates (in accordance with department policy).

Updates status of financial clearance activities in system.

Prepares/assembles all necessary paperwork preparatory to the patient*s arrival.

Reviews/corrects third party payer eligibility reports.

Completes real time status transfers.

Authorizes occupancy and collect payment for Private Room differentials. Also reviews bed transfer list daily to endure the authorization and collection of all appropriate private room transfers. Collection of private room differentials may require visits to patient rooms.

Monitors in-house accounts for open patient balances resulting from co-payments and deductibles. Tracks Medicare days and Lifetime Reserve Days when applicable. Negotiates payment of same before discharge and/or visit patient rooms to do so when required.

Reviews all accounts prior to discharge to clear patient financially and/or direct patients to the Patient Advocate s required by department policy if they are not cleared financially at the time of discharge.

At arrival at admission or in the patient*s room may complete any missing documentation and paperwork required from patients and/or family members.

May provide bed control by assigning patient to appropriate room whenever possible and notify nursing units. Coordinates with Nursing Department to assign patient beds in accordance with case management guidelines. Explains policy for private room requests and collects deposits when applicable.

Monitors the bed tracking system for bed availability and bed status. Coordinates bed cleaning with the ESD department whenever necessary.

Reviews newly assigned medical record numbers for duplication reporting all duplicates on appropriate form.

Attends and participates in staff meetings

May be required as needed to provide coverage to numerous locations (hospital-based Admitting ED and Outpatient areas as well as off-site registration areas) to meet patient/customer needs

Protects and preserves patients right to privacy and confidentiality.

Utilizes department equipment: i.e. fax machine phone visa machine laptop PC and other technology as developed.

Performs other related duties as required to support the operations of the Department.

Other information:
BASIC KNOWLEDGE:

High school diploma or equivalent.

Knowledge of medical terminology third party insurance information and standard office computer applications required.

Knowledge of third party payer verification and authorization process preferred.

Typing and data entry skills required.

EXPERIENCE:

Six to twelve months previous third party billing or hospital registration experience.

Third party billing knowledge.

Data entry skills and PC experience required.

WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:

Sitting for long periods of time at a workstation requiring the continuous use of a computer and telephone.

May have to do moderate to excessive walking depending on the location of the assignment.

Ability to lift up to 10 pounds.

Brown University Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status. Brown University Health is a VEVRAA Federal Contractor.

Location: The Miriam Hospital USA:RI:Providence

Work Type: Full Time

Shift: Shift 2

Union: Non-Union

Test