The Patient Access Associate II must be competent in the following: registering, insurance/Medicare/Medicaid compliance and strong customer service skills, and processing drop-off specimens. The Patient Access Associate II must have the ability to work independently in a fast-paced environment. The Patient Access Associate II must project a mature, compassionate, concierge-style customer attitude and professional demeanor. Interacting in a customer-focused and compassionate manner to ensure patients and their representatives needs are met, and that they understand the hospital's revenue cycle expectations, including resolution through various payment options. The Patient Access Associate II will accurately collect, analyze and record demographic, insurance/financial and clinical data from multiple sources, and obtains other information and signatures necessary for registration and billing. Effectively screens for compliance with payer requirements for medical necessity and precertification and completes third-party eligibility and benefit verification to ensure accurate payment is secured.
Experience/Education Requirements
High school diploma or its equivalent
EKG tracings preferred
Computer literate
Medical terminology preferred
Office or other clerical experience preferred
Ability to read and write in English. Verbal skills required to interact on the telephone or in person in a courteous and respectful manner
Ability to do general arithmetic
Prior knowledge of payer regulatory compliance and HIPAA Privacy and Security requirements
Detail oriented, committed to accuracy, ability to problem solve
Understanding of the hospital revenue cycle
License Or Certification Requirements
None
Responsibilities
Accurately collects and analyzes all required demographic, insurance/financial and clinical data necessary to schedule, pre-register and register patients from all payer classes, interacts with patients, their representatives, physicians, physician office staff, employers, and others, and review new and previously recorded information, electronically records information on a timely basis, follows EMTALA, HIPAA, payer and other applicable regulations and standards for registration.
Analyzes available documentation and uses hospital resources to provide the amount expected from the payer and the amount owed by the patient or responsible party.
Provides the information to patients to ensure they understand the policies that govern the revenue cycle and the processes that will be followed.
Appropriately explains, secures, and witnesses all signatures required to provide medical treatment, assignment of benefits, release of information, establish financial responsibility and to assist in meeting other internal, regulatory and payer requirements.
Completes the MSP questionnaire when applicable. Assist with procedures and diagnostics from pre-op testing.
Assists in clinics or other departments' needs as necessary including: escort patients to exam rooms; take vital signs (height, weight, BP); assist with procedure and diagnostic test upon request; assist with documentation when requested; perform EKG tracings.
Assists with transportation of patients within the hospital and in securing transportation of patients to and from the hospital.
Attend all mandatory meetings and all advanced registration classes.
Complete registrations for drop off specimens. Confirm special requirements for specimen acceptability before and/or after delivery of specimen.
Determines from callers appropriateness of services to be provided in department and other locations to ensure proper information is provided to patient or their representative prior to arrival. Generates Outpatient Center staff schedule.
Reviews and makes necessary revisions to time card to ensure staff's time is recorded accurately.
Keeps patients and family informed of process and any delays.
Obtain specimens utilizing venipuncture and other means of collection.
Draw tubes in correct order to avoid contamination or carryover in specimen.
Make sure all tubes are full or filled to an acceptable level. Appropriately labels, stores and transports all specimens according to laboratory policies and procedures.
Notifies supervisor(s) when unable to collect an acceptable specimen after two (2) attempts. Notifies supervisor(s) of any unusual problem(s) with specimen, patient, physician, orders, etc.
Oversees departmental expenses such as SMR and operational expenses.
Adjusts staffing level to meet budgetary requirements while ensuring patient and customer satisfaction.
Oversees the Outpatient Center and informs Director of issues with center for follow up or resolution.
Provides preps and instructions to patients to ensure necessary steps are taken prior to tests/procedures.
Provides training, mentoring, and ongoing education to outpatient center staff.
Acts as a role model to staff.
Receives, properly responds to, or redirect telephone, electronic and in-person inquiries from patients, their representatives, payers, physicians, and their staff, UR, internal departments, and other persons.
Maintains confidentiality of personal health information working within the minimum necessary guidelines.
Reviews and analyzes records of active patients to identify and resolve situations where care is different than originally identified, including reverification of payer information, reverification of medical necessity, revising and informs all affected parties.
Reviews physician orders and other documentation against payer coverage and medical necessity criteria, uses screening software to determine whether services being provided meet third-party requirements for payment, contacts physicians as necessary for additional clinical information, informs physicians about payer requirements, initiates Medicare ABN process as appropriate and explains payer policies to patients.
Documents in notes all financial expectations of payer or patient and medical necessity verification.
Reviews quality of staff's work ensuring staff is meeting expectations and competencies for laboratory.