Patient Access Representative - Stone County Medical Center

Title:  Patient Access Representative I

Department: Patient Access

Reporting Relationships: SCMC Manager of Financial Services

Job Summary: Registers patients admitted to the hospital or receiving emergency, outpatient, surgical, therapy, or visiting physician services in a friendly, accurate, and timely manner. Obtains and verifies demographic, guarantor, insurance, and relevant medical information to establish complete patient accounts. Provides service estimates when applicable, explains patient financial responsibility, and receives and processes payments for current and past balances. Works to reduce registration delays and improve communication and patient satisfaction. Supports management and teamwork while reflecting the mission, philosophy, and core values of White River Health and the assigned facility. This position has no supervisory responsibilities.

Job Duties:

§ Verify patient identity using appropriate identification documents, such as a driver’s license, identification card, or passport, according to policy. Collect and enter accurate patient demographic, guarantor, financial, insurance, and relevant medical information.

§ Enter required insurance and billing information using the correct payer, insurance codes, and financial class. Request the insurance card at every date of service and verify information against the front and back of the card.

§ Obtain complete information for motor vehicle accidents, school accidents, workers’ compensation, and other accident-related claims. Complete required forms, document the information on the account, and forward accident forms to Revenue Claims or the appropriate department.

§ Document reasons for incomplete registration information and follow up on missing items. Scan required documents into the correct patient chart categories and compile and distribute forms to the appropriate departments.

§ Complete patient status and room transfers accurately using Meditech worklists, telephone calls, faxes, and information from nursing staff or providers. Review daily work and correct errors before the end of the shift.

§ Verify all insurance coverage using AccuReg, the electronic verification system, payer websites, or telephone contact. Enter the correct coverage and payer information on the patient account.

§ Confirm applicable payer and registration requirements, including primary care provider requirements, medical necessity screening, and required notices such as the Important Message from Medicare. Verify Medicaid coverage and assist with PCP selection or assignment when needed according to payer procedures.

§ Perform medical necessity screening for applicable services, including unscheduled services. Communicate unmet requirements to the referring physician and seek clarification or appropriate supporting documentation. Obtain and scan an Advance Beneficiary Notice when applicable under established policy.

§ Complete pre-registration when applicable, including review of patient information, insurance requirements, and patient financial responsibility.

§ Assist Radiology and other outpatient departments with verification and pre-certification. Obtain or coordinate required pre-certification or prior authorization for surgery, observation, and inpatient services as assigned.

§ Use accurate demographic and financial information to estimate patient responsibility, including copayments, deductibles, coinsurance, and deposits. Provide estimates when appropriate.

§ Explain financial responsibility and the variables affecting estimates. Answer patient questions and request copayments, estimated liability, or deposits according to point-of-service policies.

§ Collect outstanding patient balances as assigned. Receive and process payments for current and past accounts, issue receipts, forward required receipt copies, and post payments in the appropriate system.

§ Maintain necessary petty cash according to policy. Complete end-of-day closing and reconciliation, including payment activity and deposit slips.

§ Answer department telephones and relay verbal and written messages promptly and accurately.

§ Answer main telephone lines when PBX is not answered or when assigned coverage. Transfer calls to the correct department or patient room and follow PBX policies.

§ Know emergency and security codes, the proper process for announcing or calling a code, and the required response to each code. Perform assigned code procedures promptly and professionally.

Responsibilities by Assigned Work Area:

Employees are expected to be knowledgeable about registration responsibilities across locations and provide coverage as assigned. Duties are not limited to a single decentralized registration area.

Main Admitting: Register direct admissions, outpatient testing, and therapy evaluations; assist with telephone coverage and Meditech worklists. The SCMC source lists main admitting hours as 7:00 a.m. to 5:00 p.m., Monday through Friday.

Surgery: Pre-register and register surgical patients, obtain or coordinate prior authorization as assigned, assist with telephone coverage, and manage Meditech worklists. Hours vary according to scheduled cases, Monday through Friday.

Emergency Department: Register emergency patients and provide registration coverage for direct admissions and outpatients after Main Admitting closes. Provide PBX and incoming telephone coverage and manage Meditech worklists as assigned. Emergency registration operates 24 hours a day, seven days a week, including holidays.

Visiting Physicians: Register visiting physician patients as requested. Hours vary according to service needs.

Qualifications:

Education: High school diploma or equivalent.

Training and Experience: Previous customer service or healthcare experience. One year in a hospital, similar medical facility, or physician’s office is preferred. Consideration of applicants without previous experience based on education requires confirmation of the final approved qualification standard. Completion of a medical terminology course or willingness to complete the course within one year of employment.

Job Knowledge:

§ Basic computer skills, including data entry, keyboard and mouse use, and obtaining information from websites.

§ Ability to follow oral and written instructions and communicate clearly in person, by telephone, and in writing, using correct spelling and grammar.

§ Ability to manage multiple tasks, exercise sound judgment, and solve problems independently or with a team.

§ Flexibility to work variable shifts, weekends, holidays, and overtime when needed.

Essentials:

§ Work closely with department coworkers, physicians, nurses, physician office staff, and other hospital departments. Promote positive relationships with patients, families, employees, managers, medical staff, volunteers, and community members.

§ Provide courteous, respectful, and compassionate service. Remain professional when others are upset and handle difficult situations tactfully. Recognize service recovery opportunities and follow policy.

§ Communicate in a manner appropriate to the patient’s age and developmental needs. Understand customer expectations and strive to meet or exceed them.

§ Prioritize work according to department needs, standards, and deadlines. Work independently with minimal direct supervision or as part of a team. Resolve problems within the role, address interdepartmental concerns effectively, and follow the chain of command when higher-level intervention is needed.

§ Accept new responsibilities with openness and cooperation. Adjust work schedules to department needs, assist coworkers, identify tasks requiring attention, and seek practical improvements that prevent recurring problems.

§ Participate in employee orientation, training, and cross-training. Maintain and care for equipment and supplies, and keep work areas and waiting rooms neat, clean, and organized.

§ Perform other similar duties assigned by supervision within the registrar role.

§ Maintain confidentiality of patient, medical staff, employee, training schedule, and other protected or confidential information. Access electronic patient health information only as authorized. Specific systems and access levels are defined on the Security Clearance Request Form.

§ Follow safety, infection control, and Environment of Care requirements. Use protective equipment and appropriate precautions when exposure to blood, body fluids, or chemicals is possible. Know the location and proper use of fire extinguishers and other job-related equipment; participate in skills fairs and fire and disaster drills.

§ Report to work fit for duty and free of adverse effects of illegal drugs, medical marijuana, prescription medication, or alcohol.

§ Complete required competencies and education and develop individual educational objectives consistent with health system expectations. Attend at least 75 percent of monthly unit meetings, or nine of twelve meetings.

§ Follow hospital conduct policies, including smoking restrictions and personal telephone use. Dress professionally, wear the identification badge, and comply with dress code policy 20:10. Record time accurately in Kronos or the designated timekeeping system and comply with attendance policy 70:01.

Physical Demands: Work occurs in a normal office and hospital environment with significant patient and public contact. Duties require extended computer use, operation of job-related equipment, and visual, auditory, and tactile abilities. Employees must communicate clearly, use a keyboard and mouse, move throughout halls, stairways, and patient rooms, and obtain information or signatures at the bedside. Emergency Department duties include promptly reaching the EMS entrance to register patients and moving through the facility in response to hospital emergencies.

Draft review note: Confirm the final reporting relationship and experience requirement. The original PAR I description reports to the Patient Registrar Lead and requires previous customer service or healthcare experience. SCMC reports to the Director of Financial Services and permits consideration of applicants without previous experience based on education.

Employee Acknowledgment:

I have reviewed and understand this job description and the responsibilities of the position. I understand that failure to perform assigned responsibilities may result in disciplinary action, up to and including termination.