Overview

This position will function as a subject matter expert for the department and will help coach and mentor less experienced staff on all aspects of Patient Access Services (PAS) and the Revenue Cycle.

This position is responsible for completing the financial clearance process within PAS and creating the first impression of WTH’s services to patients and families and other external customers. The PAS Representative must be able to articulate information in a manner that patients, guarantors, and family members understand so they know what to expect and an understanding of their financial responsibilities. This position assumes responsibility for collecting and documenting information on behalf of the patient. Responsible for obtaining, coordination, and directing information from patients, physician offices, hospital departments, and clinics in order to schedule patient appointments.

The PAS Representative will be responsible for completing the pre-registration, registration, insurance verification, benefits verification, certification, referral management, patient liability collections, and medical necessity check – as well as interviewing patients and guarantors to obtain information to screen for financial counseling, verifying eligibility and corresponding benefit levels, coordinating referrals and obtaining treatment authorizations. PAS reps may also be responsible for scheduling patients.

The PAS Representative will also work with medical staff, nursing, ancillary departments, insurance payers, and other external sources to assist families in obtaining healthcare and financial services.

Responsibilities

Leadership - Provides hands on training to new employees and works with existing employees who require retraining or need to learn a new aspect of their job.

Provides coaching and mentoring to less experienced team members on all aspects of the revenue cycle, payer issues, policy issues, or anything that impacts their role.

Reviews and resolves accounts that are complex and require a higher degree of expertise and critical thinking.

Performs accuracy audits on patient accounts as directed.

Registration - Performs financial clearance process by interviewing patients and collecting and recording all necessary information for pre-registration and registration of patients. Ensures that proper insurance payer plan choice and billing address are assigned in the automated patient accounting system. Verifies relevant group/ID numbers.

Completes the registration process according to established policies and procedures.

Ensures patient receives necessary disclosures, privacy information, and signs the relevant documentation.

Financial Clearance - Contacts payers to verify insurance eligibility. Completes automated insurance eligibility verification, when applicable, and appropriately documents information in the patient accounting system. Determines the patient’s insurance type and educates patients regarding coverage and/or coverage issues.

Responsible for obtaining complete and accurate demographic, financial, and clinical information to help ensure maximum reimbursement for the hospital.

Informs families with inadequate insurance coverage regarding financial assistance through government and financial assistance programs. Performs initial financial screening and refers accounts for financial counseling and/or appropriate eligibility assessments.

Ensures all referrals and treatment authorizations for all patient types have been obtained according to the outlined requirements. If not obtained, contact payers for approvals.

Completes initial medical necessity checks. Refers to designated area if medical necessity fails or if referrals /authorizations are denied.

Pre-Service/ Point of Service Collection - Interprets third party payer policies to establish patient financial liabilities and work with patients so they understand their patient financial responsibilities.

Collect co-payments, co-insurance, and deductibles according to pre-service/ point of service collections policies and procedures.

Communication & Miscellaneous - Advises next-level leader of possible postponement or deferrals of any elective/non-emergent admission which has not been approved prior to service date. Maintains accurate files for pre-processing information as required.

Investigates, resolves, and documents patient problems in a timely and efficient manner. Maintains accurate files for pre-processing information.

Demonstrates excellent communication skills and the ability to work with all levels of staff to resolve urgent issues in a prompt and professional manner.

Investigates, resolves, and documents patient problems and contact medical staff, nursing staff, ancillary departments, and administration as necessary.

Assists with cross training function in areas within Patient Access Services.

Performs related responsibilities as required or directed.

Referrals-assist with referrals going to outside facilities. Must submit for prior authorization if needed, contact facility to setup appointment, etc. Follow through with referral process until patient has been contacted with appointment.

Referrals-assist with referrals internally. Must submit for prior authorization if needed, schedule appointment within clinic. Follow through with referral process until patient has been contacted with appointment.

Qualifications

EDUCATION:

High School Graduate, or equivalent

LICENSURE, REGISTRATION, CERTIFICATION:

N/A

EXPERIENCE:

2-3 years health care or related experience required