The Patient Access Specialist is responsible for many types of interactions such as point-of-service, face-to- face, as well as telephone, web enabled, and/or through an interpretative service related to completing the patient registration and admission process.  They will greet patients and guests in a courteous manner while initiating the scheduling or check-in process. They will obtain and verify accurate identification and demographical data for the patient's permanent medical record, which assists in accurate reimbursement, while recognizing and maintaining the confidentiality of all patient information.

DESCRIPTION OF DUTIES:

General

1.      Completes the registration, messaging, and/or admissions process. Greets patients, guests and family members.

2.      Analyzes current patient information to determine if an account already exists so as not to duplicate records.

3.      Registers patients by entering accurate demographic information, financial class and insurance information.

4.      Demonstrates working knowledge of payer types, rules and guidelines to ensure accurate registration insurance verification.

5.      Ensures all required forms are completed and other paperwork/documents are gathered and accurate before end of shift.

6.      Ensures patient/guarantor signs all applicable documentation, such as consents and financial assistance application. Scans ID’s, insurance cards, orders, authorization information, etc. into the patient’s account.

7.      Performs insurance verification tasks, including running automated eligibility response at point-of-service to ensure active coverage and completing notification of admission with insurance company within established timeframe.

8.      Updates Evident Electronic Medical Record with documentation to communicate any information related to the status of a patient account.

9.      Identifies patient copayment and explains collection process at time of visit. When applicable, will inform patient/guarantor of liability due, including prior balances and estimates for scheduled service.

10.  Attempts to collect payment at point of service for both copayments and residual payments.

11.  Provides patient information on HMH’s financial assistance programs and/or refers patients to the Patient Account Representative as needed.

12.  Provides excellent customer service to all internal and external team members/customers.

13.  Promotes a customer centered experience by performing all functions in a warm and courteous manner to patients, family members, providers, and all visitors of the organization.

14.  Answers incoming calls and transfers calls to appropriate areas of the hospital.

15.  Provides directions to applicable areas of interest whether over of the phone or in-person.

16.  Knowledgeable in all the job duties listed below.

17.  Performs other duties, projects, or subjects as assigned by department manager.

18.  Follows all departmental and organizational policies and procedures.

19.  Follows Hood Memorial Hospital’s Compliance Programs and federal and state regulatory guidelines.

 Admit/Precertification

1.      Responsible for obtaining and insuring precertification is completed, and an approval of services is obtained prior to the patient’s admission.

2.      Handles precertification and registration of recurring patients.

3.      Acts as the Patient Access representative at the weekly wound care clinic.

4.      Reverifies insurance benefits periodically for Swing patients and recurring patients.

Outpatient Registration

1.      Checks Medical Necessity of tests ordered by physicians for ancillary services.

2.      Contacts physician’s office when necessary to obtain diagnosis required for medical necessity.

3.      If a qualifying diagnosis is not obtained, get a signed Advanced Beneficiary Notification as required by CMS, as well as a signed notice accepting financial responsibility for the test or declination of the test.

4.      Maintains Standing Order File.

5.      Preregisters patients for nursing home draws.

 Emergency Room

1.      Registers patients promptly and obtains copies of insurance information while the patient is in the emergency room.

2.      Obtains ER copay or payment upon discharge from the patient.

3.      Ensures that information entered is as accurate as possible and the correct discharge time and disposition is entered.