Job Code/Title: Patient Access Representative

Department Name: Registration

Reports To (Title): Patient Access Supervisor

FLSA: Non- Exempt

Summary: Responsible for patient registration, admissions, and associated tasks which include information collection and validation, and requisitioning of orders and services. Insurance-related tasks include verification, collection of co-payments, and collection of associated paperwork. Performs administrative functions, scheduling, answering phones, and coordinating general requests.

Essential Functions:

A:  Job Specific

• Registers patients and performs all registration-related functions, including explaining and obtaining all necessary patient consents and authorizations in a complete and timely manner, collecting financial paperwork (e.g., patient responsibility statement, etc.), and co-payment as required
• Communicates effectively with patient to assist in access to care by answering telephone and other incoming communications in a timely and customer-service oriented manner; replying to inquiries, patient needs for information, and other parties clearly and in a timely manner; and, if information is not readily available, follows up with inquiries to responsible party
• Resolves all non-clinical questions within scope of knowledge while providing excellent customer service on the phone and/or in person
• Performs on-going documentation audits for medical necessity, plan of care, and other related tasks or requirements by payors, including Medicare, using a variety of computer-based systems
• Schedule appointments for outpatient clinics and procedures as needed
• Obtain prior health insurance authorization for outpatient procedure and inpatient stay as needed.
• Educate each patient with pre-exam and if necessary, post-exam requirements within scope
• Organizes, generates and distributes patient reminders, results, and recall letters
• Establishes files, maintains information, and scans medical records in a timely and organized manner
• Ensure the accuracy of medical record documentation by performing a quantitative and qualitative audit.
• Manages, directs and responds to incoming office correspondence as deemed appropriate, including mail, email, faxes, and telephone calls, and forward queries to the appropriate staff
• Attends and provides feedback for departmental staff meetings
• Role Models the Principals of Rise Community Hospital and Organizational Values.
• Ensures compliance with all applicable HIPAA, EMTLA and Joint commission requirements, providing required associated literature to patients
• Performs other duties as assigned on department and organizational level.
   

B:  Company Specific

• Adheres to dress code, appearance is neat and clean and wears appropriate identification while on duty.
• Completes annual health, safety, and education requirements.  Maintains professional growth and development.
• Maintains confidentiality of all patient and/or employee information to assure patient and/or employee rights are protected.
• Demonstrates knowledge of the principles of growth and development over the life span and the skills necessary to provide age-appropriate care to the patient population served.
• Reports to work on time as scheduled; adheres to policies regarding notification of absence.
• Attends all mandatory in-services and staff meetings.
• Represents the organization in a positive and professional manner.
• Complies with all organizational policies regarding ethical business practices.
• Communicates the mission, ethics, and goals of the hospital, as well as the focus statement of the department.
• Maintains current licensure/certification for position, if applicable.
• Consistently demonstrates Guest Relation’s skills to patients, physicians, visitors, employees, and any other individuals with whom they may come in contact.
• Consistently follows departmental and hospital Health, Safety, Security, Hazardous Materials policies and procedures.
• HIPAA: Conduct job responsibilities in accordance with HIPAA privacy laws, follow hospital policy in provision of patient confidentiality. Able to identify patient confidentiality issues and reports to proper hospital personnel immediately.
• Compliance: Conducts job responsibilities in accordance with standards set forth in Rise Community Hospital Code of Conduct, Rise Community Hospital policy and procedures, applicable federal and state laws, and applicable standards.
• Employee must maintain a courteous and respectful attitude toward fellow employees, staff, contractors, vendors and the public at all times. Employee must avoid loud, profane, or unprofessional language at all times during the performance of duties. It is immediate grounds for termination if Employee engages in misconduct or is incompetent or negligent in the proper performance of duties or is disorderly, dishonest, intoxicated, or discourteous.

Qualifications:

Education: High School diploma or GED required, associate degree or higher preferred

Licenses/Certification:  BLS certification required, CHAA or CHAM preferred

Experience: 1- year experience in an acute patient care setting preferred

Disclaimer:

This description is designed to indicate the general nature and level of work for this position.  It is not intended to describe minor duties or other responsibilities that may be periodically assigned.