Patient Access Representative I

Job Details

Miller County Medical Center - COLQUITT, GA

Full Time

Day

Health Care

Description

JOB SUMMARY:

The Patient Access Services Representative Patient Access Specialist I is an entry-level position focused on learning and

mastering the fundamental aspects of patient registration and customer service. The specialist will work under close

supervision while gaining confidence and accuracy in registration processes. Performs all outpatient

registration functions and performs insurance verification. Ensures that patients meet financial

requirements. Provides general information to office/clinic users, patients, and families. Communicates effectively to

service delivery areas to maximize patient flow and customer service. Provides excellent patient focused customer

service.

GENERAL REQUIREMENTS:

Performs all job responsibilities in alignment with the mission and vision of the organization.

Performs other duties as required and completes all job functions as per departmental policies and procedures.

Maintains current knowledge in present areas of responsibility (i.e., self-education, attends ongoing educational programs).

Attends staff meetings and completes mandatory in-services and requirements and competency evaluations on time.

Wears protective clothing and equipment as appropriate.

GENERAL SKILLS:

Ability to communicate in English, both verbally and in writing.

Additional languages preferred.

Strong written and verbal skills.

Basic Computer Skills

WORKING CONDITIONS:

General environment: Works in a well-lighted, air-conditioned area, with moderate noise levels.

May be exposed to high noise levels and bright lights.

May be exposed to limited hazardous substances or body fluids, or infectious organisms.

May be required to change from one task to another or different nature without loss of efficiency or composure.

Periods of high stress and fluctuating workloads may occur.

May be scheduled as needed including overtime.

PHYSICAL REQUIRMENTS & DEMANDS:

Have near normal hearing: Hear alarms/telephone/normal speaking voice.

Have near normal vision: Clarity of vision (both near and far), ability to distinguish colors.

Have good manual dexterity.

Have good eye-hand foot coordination.

Ability to perform repetitive tasks/motion.

Continuously within shift (67-100%): Standing, Walking.

Frequently within shift (34-66%): Bending/Stooping, Pushing/Pulling, Lift/carry up to 20lbs, Lift/carry > 20 lbs. with assistance.

Occasionally within shift (1-33%): Sitting, Climbing, Twist at waist, Lift/Carry > 50 lbs. with assistance, Reaching above shoulder.

MISSION STATEMENT:

QUALITY HEALTHCARE: In our continuing effort to enhance the quality of life for the communities we serve, the Hospital Authority of Miller County is committed to the delivery of superior, safe, cost-effective healthcare through the provisions of education prevention, diagnosis and treatment.

JOB SPECIFIC COMPETENCIES:

Responsible for obtaining necessary demographic and financial data through patient interviews and system queries to complete the pre-registration process.

Assures all check-in procedures are completed, and monitors patient wait times, communicating changes to the patient, as necessary.

Reads and interprets insurance responses.

Communicates financial obligations to patients and collects fees at time of service as appropriate.

Accurately performs medical record maintenance and releases.

Performs cash posting following department guidelines.

Abides by organizational and HIPAA guidelines, privacy practices, patient confidentiality and patient rights.

Must maintain high regard for confidentiality.

Notifies patient or guarantor of anticipated financial responsibility including copays, deductibles, or coinsurances and collects accordingly. Performs cash posting following department guidelines.

Communicates the purpose of and completes all necessary regulatory forms with patients.

Completes patient's visit by scheduling any necessary follow-up appointments to include any specialty or ancillary services as possible.

Familiar with Advance Beneficiary Notice, Medicare Secondary Questionnaire, Medicare Outpatient Observation Notice, Important Message from Medicare, precertification, ICD-10 coding, Medical Terminology.

Identifies patients who require early financial counseling intervention.

Maintains knowledge of departmental applications i.e., CERNER, Relias, Heartland, Hometown Health, GAMMIS, Availity, my ABILITY, and other systems utilized by Patient Access Services.

Multiple tasks and responsibilities. Must pay attention to detail. Ability to perform efficiently and effectively under stress.

Presents consent forms and notifications to patients and obtains all necessary patient signatures and information at time of arrival.

Verifies patient’s insurance eligibility utilizing assigned tools, updates information in patient’s account as needed.

May initiate and perform administrative duties to ensure efficient daily business operations, including participating in the office/department opening and closing procedures, assisting with maintaining, ordering, and restocking front office supplies, and receiving and distributing mail.

Prepares the next day’s work for all scheduled patients.

Answers the phone in a professional and courteous manner; take messages; direct calls to appropriate staff members.

Scan copies of photo ID and insurance verification each visit.

Collects payments, balances petty cash.

Calls for transportation for patient, etc.

Additional Responsibilities: May be separate from PAR Duties

Auditing and Quality Review

In addition to core registration responsibilities, the Patient Access Representative will perform regular audits and quality checks to ensure accuracy, compliance, and optimal patient experience. The following auditing duties are included in this role:

Auditing Responsibilities:

Insurance and Verification and Accuracy:

Review and verify insurance information for all Inpatient and Swing Bed admissions to ensure accurate and up-to-date coverage is documented.

Required Documentation Compliance:

Confirm that all required patient forms, including but not limited to the MOON (Medicare Outpatient Observation Notice) form, have been properly signed by the patient and their guarantor.

Primary Care Provider Accuracy:

Audit patient records to ensure that the Primary Care Physician (PCP) listed is accurate and updated in the system.

Medicare and Medicaid Eligibility Checks

For all patients listed with Medicare or Medicaid, verify eligibility and confirm there are no active Medicare Advantage or Medicaid CMO (Care Management Organization) plans that would alter billing or coverage

Portal Consent for Underage Patients

Audit portal consents for patients under age 18 to ensure proper authorization and that access limitations for minors are observed in accordance with privacy regulations.

Portal Enrollment Confirmation

Review patient portal consent forms to ensure patients who opted to sign up were successfully sent an invitation and access link. Investigate and resolve any issues preventing access.

PROFESSIONAL REQUIREMENTS:

Follows Code of Conduct policy.

Adheres to dress code; appearance is neat and clean.

Completes annual educational requirements.

Maintains regulatory requirements.

Maintains patient confidentiality at all times.

Reports to work on time and as scheduled; completes work within designated time.

Wears identification when on duty; uses computerized time clock system correctly.

Completes in-services and returns in a timely fashion.

Attends annual review and/or skills fair and department in-services, as scheduled.

Attempts to end conversations and other interactions in a positive manner; leaves others with a good impression of the Hospital Authority of Miller County and its employees.

Complies with all organizational policies regarding ethical business practices.

Communicates the mission statement of the organization.

GUEST RELATIONS STANDARDS:

(All guest relation violations are subject to disciplinary action up to and including termination):

Always treat others in a friendly, helpful manner.

Refers co-workers to proper sources when unable to provide an answer.

Interacts with others in a professional and friendly manner.

Takes interest in others and always gives full cooperation to fellow workers.

Always maintains an open line of communication with other departments.

Thoroughly familiar with the hospital and the services it offers.

OTHER:

Responsibility to Report: It is the responsibility of every employee of HAMC to comply with federal, state and local laws and regulations, as well as, HAMC Policies and Procedures. Every employee is help accountable to participate in, comply with and report concerns to his or her supervisor or the Compliance Officer if illegal or unethical behavior is suspected.

As an employee of HAMC, you have been granted user access to applicable ePHI systems based on your position. This user or role-based access is intended to give you the minimum necessary access to perform your job function(s) only and should be used only as applicable.

Qualifications

EDUCATION, CREDENTIALS & EXPERIENCE REQUIREMENTS:

High School Graduate or equivalent.

One year experience in office setting of hospital setting.

Experience with billing and insurance preferred.

Complete a 30-day and 60-day Competency Check List to become Certified as an Advanced beginner.