PreArrival Associate - Patient Access - FT Days

Job Summary: Responsible for verifying and determining the insurance eligibility, obtaining any appropriate authorizations and confirming the patient financial responsibilities prior to patients presenting for a scheduled service. This also includes contacting the scheduled patients to complete the pre-registration for the service and advising them at that time of any financial responsibilities due prior to receiving the service, collecting the patient liabilities and presenting payment options available to the patient or referring the patient to the Patient Access Outpatient Manager. It is essential that this position understands all of the insurance plan requirements, the hospital financial assistance policy and the payment options available to patients, including knowledgeable of all of the software needed to assist in the registration and collection processes. It is also the responsibility of this position to document all steps and necessary required information regarding the patient authorization and liabilities using the pre-arrival software program that is designed to track all scheduled patients. Because of all of the additional counseling with the patients required and the necessary communication required with the physician offices, excellent customer service is essential.

Primary Job Responsibilities:

• Works daily from a work list that identifies patients that are scheduled and need to be reviewed for insurance eligibility, authorizations and financial responsibilities. Also uses the Community Wide Scheduling (CWS) documentation to assist in ensuring that all addons and stats and changes are also included in the daily work list.
• Selects patients from the work list to begin reviewing the patient’s demographic information, and pertinent insurance eligibility information and benefit information. This includes making any adjustments to the program if a test is not mapped or the benefits did not calculate. This includes understanding insurance plan benefits so that any discrepancies can be determined.
• Performs in a manner that the work list is reviewed no less than two days ahead. Strives to work ahead as many as 5 days ahead when possible. Uses the software that directs patient information to a payer center to review for benefits when we know that the system will not populate automatically which will respond back within 48 hours.
• Ensures that the physician is correct on the information provided. If not, ensures that the schedulers are aware of the incorrect information.
• Determines insurance authorization by contacting the insurance companies online by utilizing system tools or by contacting insurance companies directly. If the insurance company requires additional physician information, this includes contacting the physician offices to obtain their assistance in obtaining the insurance authorization. All stats and addons and changes are reviewed immediately to determine if authorization requirements can be met prior to the service. Any issues communicated to the service department immediately.
• Performs the pre-registration process, which includes reviewing with the patient prior to the service their demographic information and their financial responsibilities due prior to the date of service. This includes collecting the patient liabilities over the phone by credit card and discussing payment options available to them including payment plans, a medical loan or referring the patient to the Financial Counselor to discuss financial assistance eligibility.
• Works with Financial Counselor to determine what patients should be submitted to Centauri for after-hours assistance. This includes reviewing the spreadsheet the next day to determine if there was communication with the patient and the status to determine if there are any other steps that need to be taken for day of service.
• Communicates with the Financial Counselor when patients are unable to meet their financial responsibilities prior to the date of service, this includes providing any previously obtained information.
• Understands the cashier responsibilities and the balancing of the drawer at the end of each day.
• Prepares documentation and information for the registration staff so that they are aware of the prior communications with the patient and aware of any financial responsibilities due at the time the patient presents for the service.
• Documents all steps and comments into the appropriate systems so that all parties are informed and tracking reports will have complete information on each patient.
• Performs other miscellaneous assignments and/or duties as related to the position.

Education Requirements and Other Requirements:

Education Level: High school diploma or equivalent.

Prior Patient Access experience is required.

Prior Customer Service experience is required.

Experience Requirements: Prior Experience as a Patient Access Associate

Typing skills of 40-50 wpm

Medical Terminology course or background preferred

Excellent communication and customer service skills needed

Computer and organizational skills.

1-2 years of registration experience with a detailed knowledge of

insurance companies required.

Collection experience a plus.