Patient Access Service Representative

SUMMARY:

Serves as first point of contact for customers of TMC HealthCare; initiates the entry point for requested healthcare services and revenue management.  Responsible for computerized patient scheduling, registration, and insurance authorization and/or benefits information for either ancillary or surgical procedures. Maintains and fosters effective public relations with patients and visitors. 

ESSENTIAL FUNCTIONS:

Exhibits excellence in customer service through appropriate attitude and interaction with all patients, visitors and staff; adheres to and supports team members in exhibiting TMCH values of integrity, community, compassion, and dedication.

Collects deposits or deductibles and advises patient or guarantor of insurance benefits and anticipated cost estimates; ensures that cash handling follows corporate policies.

Ensures completion of financial documentation in accordance with TMCH’s credit and collection policies.

Explains all necessary compliance forms and obtains patient signature as required for regulatory agencies.

Performs medical necessity screening and ensures compliance with system requirements.

Interacts with physicians and/or physicians’ office staff to secure diagnosis, procedure details or authorizations and information for denials as needed.

Uses medical terminology and scheduling knowledge to select correct procedure when scheduling and coordinates information with other departments as needed.

Demonstrates knowledge of resources, staffing, instrumentation, and equipment specific to procedures to avoid scheduling conflicts.

Performs patient registration activities to ensure accurate financial and biographical data and documentation have been obtained and properly entered into hospital records. 

Completes insurance processing; including account creation, insurance verification, notification, and authorization functions, follow ups on denials and no response claims.

Communicates with departments/physicians for special requests, emergent cases, overbooking and add-ons; informs management about issues/problems with tools/times.

Handles incoming telephone calls and exercises judgment in scheduling caller for correct procedure in appropriate service area; receives telephone requests to schedule from patients, physicians, physician office staff, employers, and hospital personnel, if applicable.

Explains procedure preparations to patients so they are properly prepared before arriving at the hospital or clinics as needed.

Documents all notification, authorization and eligibility information in the registration systems, uses electronic verification tools and web-based resources.

Analyzes patient accounts, determines non-collectable accounts, and recommends bad debt or charity write-offs when applicable; analyzes and processes contractual write-offs.

Arranges payment methods or extensions of credit with patients or representatives; evaluates accounts and determines payment dates based on patient’s ability to pay and hospital policies; explains charges, services, and hospital policy regarding payment of bills.

Arranges account collections and contacts carriers to follow-up on balances due.

Maintains current working knowledge of payer regulations, contractual agreements, computer updates, and new collection tools including understanding of the Fair Debt Collection Practice Act.

Provides information about external financial assistance, including recommending third parties.

Processes Accounts Payable transactions such as: checks and posts payments to accounts receivable and verifies account balances; prepares, reconciles, balances, and batches daily deposits and prepares receipts for deposits; verifies totals on reports and forms as required. Reviews accounts with unusual balances after posting payments and adjustments. Researches and transfers monies between logs, as needed.

Adheres to TMCH organizational and department-specific safety, confidentiality, values policies and standards.

Performs related duties as assigned.

Integrative Pain Specialist

In addition to the essential functions, Patient Access Service Representatives in the Integrative Pain Specialist outpatient clinics may be responsible for scribe duties as needed.

MINIMUM QUALIFICATIONS

EDUCATION:  High School diploma or General Education Degree (GED), or an equivalent combination of relevant education and experience.

EXPERIENCE: Preferred minimum of one (1) year medical office and/or hospital experience to include healthcare eligibility and benefit analysis or scheduling experience for diagnostic testing and/or surgery.

LICENSURE OR CERTIFICATION:  None Required.

KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge of office management practices, including billing and scheduling within healthcare.
• Knowledge of basic computer familiarity and experience and the ability to operate basic office equipment. 
• Skill in evaluating patient’s needs or following up with a care-giver and then providing follow up support to patients.
• Ability to read or listen and comprehend simple instructions, short correspondence, and memos.
• Ability to write simple correspondence; ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization. 
• Ability to read and interpret documents such as safety rules, procedure manuals, and governmental regulations. 
• Ability to effectively present information and respond to inquiries or complaints from patients and/or their representatives and the general public.
• Ability to provide excellent customer service via phone and walk-ins.
• Ability to interpret and explain insurance benefits and patient financial responsibility. 
• Ability to apply common sense understanding to carry out simple/detailed written or oral instructions.