Patient Access Specialist-F/T Clinic

Description

Job Summary

To provide excellent customer service during the patient access/intake process according to established hospital procedures. The Patient Access Specialist (PAS) executes patient access through the continuum of the revenue cycle that supports patient safety, efficiency, cost reduction and service improvement. Patient Access includes the patient's pre-encounter, encounter and post-encounter which include accurate and efficient patient registration, insurance verification, scheduling, and pre-service collections in compliance with payer and facility rules and regulations.

Description of Duties

1. The PAS ensures patient safety by completing all scheduling and registration processes according to department patient identification procedures including but not limited to using two patient identifiers, reviewing patient identification documents, and interviewing the patient.

2. The PAS ensures timely access to medical care by completing patient scheduling, insurance verification, and registration processes in an efficient and timely manner and according to department guidelines.

3. The PAS ensures patient safety and promotes patient satisfaction by entering all patient scheduling, insurance, and registration information accurately.

4. The PAS supports the Patient Access Department role in the revenue cycle by scheduling according to physician orders, reviewing insurance documents, verifying coverage, and updating all insurance information in the patient's registration ensuring accurate entry of insurance information during registration to facilitate appropriate billing.

5. When required by role assignment, the PAS demonstrates a working knowledge of federal and state documentation requirements including but not limited to Notice of Privacy, Patient Rights, Financial Disclosure, Conditions of Treatment, Important Message from Medicare (IMM), Advanced Beneficiary Notice (ABN), and Advanced Directives.

6. The PAS ensures compliance with the Office of Civil Rights by providing patients with proper Notice of Privacy Practices (HIPAA) during registration and documenting per department guidelines.

7. The PAS, during registration, provides notification of and secures patient signatures as required by department procedures on documents including, but not limited to, Conditions of Treatment form, Notice of Privacy Practices (HIPAA), Advanced Directives, Patient Rights, Important Message from Medicare (IMM), Medicare Secondary Payer (MSPQ), ABN, Financial Disclosure and any other facility required forms or documents required to meet JCAHO, CMS, and DHH requirements.

8. When required by role assignment, the PAS demonstrates working knowledge of payer rules and guidelines to ensure accurate scheduling, insurance verification, and registration in order to support the Patient Access responsibilities within the revenue cycle.

9. When necessary, the PAS calls patients to obtain demographic and insurance information in order to support timely and accurate billing of all payers.

10. The PAS demonstrates basic knowledge of payer types including, but not limited to, Medicare, Medicaid, Other Governmental, Worker's compensation, Managed care, and Self-pay in order to scheduler and register patients according to department procedures and payer requirements.

11. The PAS demonstrates understanding of basic terminology as it relates to insurance guidelines including but not limited to Co-payment, Co-insurance, Deductible, Allowable/Allowed amount, Payable Rates, Payer Notification, Pre-Certification, Prior Authorization, Guarantor, Primary/Secondary/Tertiary Coverage, and Explanation of Benefits

12. The PAS documents in appointment and/or account notes as well as any appropriate comment fields as instructed any issues related scheduling, insurance verification or registration of the patient.

13. The PAS communicates according to department guidelines and effectively with patients the out estimated out of pocket responsibility. Refers patients to the Financial Assistance Center according to department guidelines and escalates patient concerns to the Patient Access management team.

14. The PAS works effectively to ensure the highest regard to customer service is given to every patient, customer, practitioner's office, and every department that utilizes the Patient Access department.

15. The PAS maintains confidentiality according to Hospital policies and procedures.

16. The PAS assists in patient conflict resolution to ensure timely access to care as well as to facilitate a positive patient experience.

17. The PAS complies with all Patient Access Department and hospital safety, environmental and infection control policies and procedures, as well as the hospital objectives and quality assurance programs.

18. The PAS follows Hood Memorial Hospital's Compliance Program and Federal and State Regulatory Guidelines.

19. The PAS enhances professional growth by participating in education programs and department meetings as required.

Other Duties and Responsibilities (Customer Service & Communications)

20. Aids, guide, and direct visitors, patients, employees, vendors and physicians.

21. Secures escort or directs patient to the appropriate service area.

22. Maintains competency in Service Recovery utilizing AAA (refer to polies and procedures).

a. A - Acknowledge

b. A - Apologize

c. A - Amend

23. Maintains personal appearance following the department and facility's dress code.

1. Establishes effective relationships with co-workers in own department as well as other departments.
2. Assists others and shows willingness to work as a team player.
3. Performs appropriately in difficult situations by remaining calm, notifying appropriate personnel, and initiating appropriate action.
4. Responds to inquiries from patients, relatives, physicians, insurance companies and the general public quickly and efficiently by actively listening and taking appropriate action.
5. Discusses problems and/or confidential information only in appropriate setting and only with appropriate personnel. Keeps any confidential documents secure and out of the public view.
6. Maintains par level of supplies and communicates to immediate supervisor when supplies are needed.
7. Ensures all equipment is functional and ready for service, including paper levels in copiers, printers, and fax machines and reports to the supervisor as needed.
8. When identified, removes and labels broken equipment or furniture from patient and visitor areas and notifies a supervisor. Immediately notifies the appropriate department to remove item and/or fix broken item.
9. Calls for all other service repairs as need is identified.
10. Performs other duties as assigned.

Requirements

1. Previous Experience Required:

• One year of previous experience in healthcare field or customer service required, experience in healthcare admissions, registration, or billing preferred. College degree can be substituted for experience.

2. Specialized or Technical Education Required:

• Medical Terminology desired; ability to communicate over the telephone; excellent customer service skills.

• Must be able to interpret complex documents related to insurance benefits.

• Must be able to read and understand physician's orders.

• Requires judgement to accurately establish patient identity, assign insurance information according to payer and facility guidelines, associate orders with scheduled services, and transcribe physician orders.

3. Manual or Physical Skill Required:

• Excellent people and communication skills, pleasing telephone voice, ability to react instantly, ability to handle more than one task efficiently, ability to meet and greet the public in a professional manner.