POSITION SUMMARY:

Patient Access / Pre-Access Representatives facilitate a welcome and easy access to the facility and are responsible for establishing an encounter for any patient who meets the guidelines for hospital service. Patient Access / Pre-Access staff ensures that all data entry is accurate including demographic and financial information for each account. Patient Access / Pre-Access has numerous procedural requirements including data elements, insurance verification, authorization for services, collections for all patient portions including prior balances and balancing of cash at shift end. Patient Access / Pre-Access staff is responsible for the successful financial outcome of all patient services. Patient Access / Pre-Access communicate directly with patients and families, physicians, nurses, insurance companies and third party payers. This position requires professional appearance, behavior, and good communication skills. Patient Access / Pre-Access representatives require dependability, flexibility, and teamwork.

CORE COMPETENCIES

Action Oriented -- Taking on new opportunities and tough challenges with a sense of urgency, high energy and enthusiasm.

Collaborate -- Building partnerships and working collaboratively with others to meet shared objectives.

Customer Focus -- Building strong customer relationships and delivering customer-centric solutions.

Nimble Learning -- Actively learning through experimentation when tackling new problems, using both successes and failures as learning fodder.

Demonstrates Self-Awareness -- Using a combination of feedback and reflection to gain productive insight into personal strengths and weaknesses.

Communicates Effectively -- Developing and delivering multi-mode communications that convey a clear understanding of the unique needs of different audiences.

Decision Quality -- Making good and timely decisions that keep the organization moving forward.

MAJOR RESPONSIBILITIES:

1. REGISTRATION / SCHEDULING

• Obtains and accurately inputs all required data elements for scheduling and registration, including patient demographic, financial information, guarantor information, and relevant notes associated with the encounter.
• Data fields include but are not limited to: address, employment, insurance info, nearest relative, guarantor, insurance plan, admitting diagnosis, working diagnosis, and physician information.
• Prioritizes and completes registrations / scheduling in a consistent, courteous, professional, accurate and timely manner.
• Ensures each patient is assigned only one medical record number.
• Selects appropriate patient type based on the department and services required.
• Communicates the purpose of and obtains patient/legal guardian signatures on all necessary hospital documents. Knowledgeable of all such documents.
• Hospital consent forms
• Assignment of benefits
• Payroll Deduction Form
• Acknowledgement of Account
• Financial Assistance Application
• Living Will (& inquires if Living Will exists)
• Advance Directive. (Obtains information from all patients over 18 years of age, and provides written information to patient when requested.)
• Patient Rights
• Documents in account notes.
• Ensures orders are received and are consistent with tests/procedures.
• Prepares account/patient folder with necessary forms completed and signed.
• Gives patient documents that he/she needs to take with him/her to other departments.

2. INSUANCE VERIFICATION / EXPLANATION OF BENEFITS

• Verifies eligibility and obtains necessary authorizations for services rendered.
• Medicare / Medicaid eligibility information through the patient admission process.
• Answer Medicare Secondary Payor Questionnaire.
• Utilizes online eligibility or Medifax when necessary for verification of Medicare / Medicaid
• Obtains online verification of major payors, including Blue Cross (I-Link Blue), State Employees Group Benefit, Tricare, United Healthcare, and others.
• Utilizes appropriate spreadsheets and worksheets to calculate patient financial responsibility.
• Performs financial assessment for appropriate program assistance.
• Utilizes appropriate guidelines to assist patient with financial responsibility.
• Demonstrates accuracy in selecting insurance plans (I-plans).

3. COLLECTIONS

• Calculates and collects the estimated patient portion based on benefits and contract reimbursement as well as prior balances.
• Utilizes appropriate language and behavior to collect patient financial responsibility.
• Collect co-payments, deductibles, deposits and /or amounts due on previous accounts.
• Knowledge and ability to review notes on all pre-admitted accounts and discuss with customer in a courteous professional manner
• Knowledge of insurance plans
• Knowledge and ability to review and explain previous accounts
• Knowledge and ability to complete payroll deduction forms, account acknowledgement forms when appropriate
• Writes or prints receipts and balances cash drawers.

4. CUSTOMER FOCUS

• Effectively meets customer needs, builds productive customer relationships, and takes responsibility for customer satisfaction and loyalty.
• Greets patients in a courteous and professional manner.
• Calls patients by name.
• Asks patients if they may have special needs.
• Represents the Patient Access / Pre-Access department in a professional, courteous manner at ALL times.

5. ERRORS

• Makes minimal errors in performing admissions / scheduling / insurance verification / pre-registration. See Error Policy and Procedure for target error rate percentage.
• Utilizes education information to reduce error rates.
• Requests additional education information when necessary.
• Demonstrates ability to select correct insurance plans.
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6. OTHER

• Required to assist the hospital in the event of an internal or external disaster.
• Supports the flexible needs of the department to accommodate patient volume in all areas of the hospital. This may require assignment to another area of the department, and shift change.
• Supports the department in achieving established performance targets.
• Completes required training as needed.
• Performs all other duties as assigned.
• Demonstrates reliability and dependability by reporting to work when scheduled.
• BUSINESS LITERACY - Understands the health care environment with its challenges and opportunities. Demonstrates comprehensive job knowledge and skills and understands the impact of personal actions on the organization.
• INTERPERSONAL RELATIONS - Promotes collaboration, open communication and team spirit.
• INNOVATION AND CHANGE - Develops individual knowledge and new skills. Improves CHRISTUS' processes, systems and performance. Resourceful and enthusiastic in responding to new challenges
• ADAPTABILITY - Maintains effectiveness during stressful situations; adjusts effectively to process changes. Flexible to meet the needs of the department and community.
• PERSONAL EFFECTIVENESS - Performs quality work, takes initiative and accepts responsibility. Meets established timelines through effective time management; seeks feedback to improve performance, and demonstrates a positive, "can do" attitude.
• DECISION MAKING - Takes action that is consistent with available facts, constraints, and probable consequences. Takes action to achieve goals beyond what is required; is proactive.