POSITION SUMMARYThe Patient Access Associate IV is responsible for the patient registration process, general admissions, and financial arrangement issues. This position verifies third party payer accounts, pre-authorization and/or pre-certification requirements. This position supports organizational goals by providing high level, quality customer service, participating in performance improvement efforts, demonstrating a commitment to teamwork and cooperation, while verifying and preparing all patient accounts for inpatient and outpatient billing to maximize payment for Hospital and Clinic services from all sources.PRINCIPAL DUTIES AND RESPONSIBILITIES
- Responsible for the patient pre-registration, registration, general admissions, and financial assistance processing.
- Will be knowledgeable of state and federal government funding programs such as Medicare, Medicaid, TRICARE/CHAMPUS, Workers' Compensation; No Fault Auto, and commercial insurance payers; billing and reimbursement guidelines and methodologies for state and federal government and non-government payers; insurance terminology; medical terminology, EMTALA, HIPAA privacy, and compliance practices.
- Ensures all demographic and insurance information is obtained and correct, and scans IDs and insurance cards, as needed. Sends query for insurance eligibility information provided by the patient and/or representative to validate eligibility and benefit information and accurately document in the registration system. Informs patients of insurance in/out of network status, as appropriate. Accurately completes the Medicare Secondary Payer Questionnaire on all Medicare eligible patients.
- Verifies insurance information through payor contact via telephone, online resources, or electronic verification system.
- Responsible for verifying diagnosis codes and completing medical necessity checks for Medicare. The Patient Access Associate IV must have basic knowledge of ICD-10 in order to ensure accurate diagnosis entry for reimbursement.
- Identifies and obtains payor authorizations, pre-certifications and/or referrals. Provides appropriate documentation and follow up to physician offices, case management department, and payors regarding authorization/referral deficiencies. Responsible for communicating to service line partners of situations where rescheduling is necessary due to lack of authorization and / or limited benefits and is approved by clinical personnel.
- In working inpatient accounts, is held responsible for timely notification to payers of the patient's admission to the facility.
- Identifies all patient financial responsibilities, calculates estimates, collects all payments due, including current estimated liabilities, outstanding balances and self-pay deposits, posts payment transactions in the system and performs daily reconciliation. Identifies self-pay and complex liability calculations and escalates account to Financial Counselors as appropriate. Responsible for all estimates requested for consumer shopper comparison.
- Appropriately collects and/or sets payment arrangements with patients or their representative, scheduling payments on deposits due, which may include screening of patients for enrollment in available credit option programs. Documents all attempts for collections, using approved verbiage, timely and consistently. Proactively seeks assistance to improve collections.
- Ensures all patients with questions or concerns regarding their bills are referred to the appropriate resource, to include initiation of financial counseling, when appropriate.
- Documents pertinent activity on the patient account via notes.
- Responsible for patient throughput, managing to metrics for established wait times and turnaround (TAT) times along with aiding in the achievement of top box customer service scores for each respective Patient Access registration site. The Patient Access Associate IV is considered a customer service champion responsible for delivering great customer service at each entry point throughout the health system.
- Maintains a current and thorough knowledge of utilizing online and system tools available, working from manual reports during system downtime.
- Communicates and collaborates with Patient Access team members and other ancillary departments as needed.
- Attends all recommended trainings and in-services and passes all competency tests associated with the in-services.
- The Patient Access Associate IV can perform all job duties based on department procedure and protocol independently.
- May be responsible for additional duties as assigned with respect to the Patient Access job scope.
QUALIFICATIONSEDUCATION AND EXPERIENCE:
- High school diploma or equivalent required. Associates degree or higher preferred.
- Minimum 5+ years' experience in Healthcare registration or relevant customer service environment
- The Patient Access Associate IV must be proficient in all requirements of Patient Access Associate II &III.
LICENSE/CERTIFICATION:KNOWLEDGE AND SKILLS:
- Ability to communicate effectively both orally and in writing sufficient to perform the essential functions; read, understand, and apply policies and guidelines; obtain information from a variety of sources is required.
- Knowledge of general computer, and data entry functions required.
- Excellent communication, customer service, organizational, and analytical skills required.
- Ability to prioritize and manage multiple tasks simultaneously, and to effectively anticipate and respond to issues as needed in a dynamic work environment. Ability to keep up in very fast paced environment required.
- Candidates must continuously display professionalism, courtesy and respect to all customers that always mirror AtlantiCare's Values/Behaviors.
- Candidate must have reliable transportation.
- Bilingual preferred.
PERFORMANCE EXPECTATIONS
- Demonstrates the competencies as established on the Assessment and Evaluation Tool for this position.
- Must pass annual recertification with score of 95% or better. This requirement is expected to be maintained every year after the upgrade. Staff member will be required to re-take training and exam until they obtain the appropriate grade or remediation action plan will be taken in regards to performance.
- Must maintain recertification on Presumptive Eligibility training as needed and pass the certification as required. This requirement is expected to be maintained continuously after the upgrade.
- Maintains high accuracy rate of 98% or higher and established productivity rates for Key Performance Indicators (KPI) such as Presumptive Eligibility application completion, cash collections, wait and TAT times, and pre-registration and registration productivityThis requirement is expected to be maintained continuously after the upgrade.
- Will attend two or more self-scheduled voluntary or facilitated education sessions with ARMC or an approved outside learning opportunity in order to enhance growth and development. The Patient Access Associate IV must be proficient and actively working as a preceptor in two or more specific areas of Patient Access.
- Will aid in training and precepting new hires upon onboarding.
- Must achieve an evaluation rating of Valued Contributor or above on their annual evaluation the year of consideration and every year after, with no written disciplinary documents on file, to progress within Patient Access Levels. If the valued contributor rating is not achieved in the following years, an action plan will be put in place to remediate the staff member back to Valued Contributor.
WORK ENVIRONMENT
- Potential for exposure to the hazards and risk of the hospital environment, including exposure to infectious disease, hazardous substances, and potential injury.
- This position requires reaching, stooping, kneeling, and crouching approximately 25% of the workday. This position requires frequently lifting, approximately 25-30 pounds, and occasional lifting of 50-100 pounds with assistance. This position also requires pushing and pulling computers on wheels approximately up to 100% of the day if assigned to the Emergency Department or Labor and Delivery. High volume fast-paced environment.
- High volume fast-paced environment.
- The essential functions for this position are listed on the Assessment and Evaluation Tool.
REPORTING RELATIONSHIP
- This position reports to department leadership.
The above statement reflects the general details considered necessary to describe the principle functions of the job as identified and shall not be considered as a detailed description of all work requirements that may be inherent in the position.