Facility:

The Hope Center

Department:

Patient Access - South Campus

Schedule:

Full time

Hours:

40

Job Details:

Patient Access Representatives provide customer-service coverage and assume the responsibility for successful financial outcomes of all patient services. Under the general supervision of the Patient Access Manager, this position performs imperative duties, which may include, but not limited to appointment scheduling, registration, transcribing orders, insurance verification, telephone coverage, data entry, filing protected health information (PHI), patient referrals, and payment collection, while maintaining patient relations, customer satisfaction, and Dayton Children's Hospital financial solvency.

Department Specific Job Details:

1. Primary Duties and Responsibilities - 50%

* Promptly fields and/or directs incoming calls and responds to patient and/or staff inquiries when necessary

* Gathers and verifies all appropriate, confidential health and financial information from patient/guarantor/subscriber while using various computer software to assure payment for all authorized services. Obtains legal consent for treatment at the time of registration

* Verifies insurance eligibility and benefits within a timeframe determined by Dayton Children's Hospital

* Verifies medical necessity in accordance with Centers for Medicare & Medicaid Services (CMS) standards and communicates relevant coverage/eligibility information to the patient

* Identifies patients who will need Medicare Advance Beneficiary Notices (ABNs) of non-coverage and maintains accurate records of authorizations within the [EHR]

* Collects out-of-pocket liabilities from patients upfront and applies, adjusts, and reconciles daily cash reports according to all organizational, state, and federal laws and regulations

* Refers patient accounts to financial advocates when further explanation/education is needed regarding denied authorizations, out-of-pocket liabilities, coverage options, payment plans, etc.

* Exhibits professionalism in appearance, hygiene, speech and conduct in accordance with organizational standards

2. Quality Improvement and Compliance - 25%

* Demonstrate awareness of department goals

* Offer ideas and suggestions to make processes more efficient

* Participate in the development of department goals and quality improvement indicators.

* Keep the supervisor informed of any problems or concerns

3. Additional Responsibilities - 10%

* Demonstrates proficient customer-service skills by greeting and treating all patients and staff with respect, discretion and dignity using AIDET standards

* Complies with all organizational, state, and federal laws and regulations related to patient privacy and confidentiality, such as the Health Insurance Portability and Accountability Act (HIPAA)

* Demonstrates understanding of insurance protocols for referrals, co-payments, deductibles, allowances, etc., and analyzes information received to determine patients' out-of-pocket liabilities

4. Education - 10%

* Participates in continuing education as needed to maintain current knowledge of role, revenue cycle and industry standards

* Stays informed of state and federal regulations in relation to hospital reimbursement, and maintains communication with personnel in HIM departments and the business office to ensure accurate reimbursement

* Stays current with all policies and mandatory education. Collaborates with patient access quality compliance coordinators, when in need of quality improvement measures, to improve overall revenue cycle accuracy

5. Performs other duties as assigned - 5%

Education Requirements:

High School

Certification/License Requirements: