Patient Access Associate - Labor & Delivery - AtlantiCare

POSITION SUMMARY

The Patient Access Associate I will perform duties after an eight week training program under the supervision of the Patient Access Leadership Team and Revenue Cycle Quality & Assurance Training Team. This position is a customer service champion responsible for delivering great customer service at each entry point throughout the health system.

This position supports organizational goals by providing high level, quality customer service, participating in performance improvement efforts, demonstrating a commitment to teamwork and cooperation while verifying and preparing all patient accounts for inpatient and outpatient billing in order to maximize payment for Hospital and Clinic services from all sources.

PRINCIPAL DUTIES AND JOB RESPONSIBILITIES

* Responsible for the patient pre-registration, registration, general admissions, and financial assistance processing.

* Will be knowledgeable of state and federal government funding programs such as Medicare, Medicaid, TRICARE/CHAMPUS, Workers' Compensation; No Fault Auto, and commercial insurance payers.

* Will be knowledgeable of billing and reimbursement guidelines and methodologies for state and federal government and non-government payers; insurance terminology; basic medical terminology, EMTALA, HIPAA privacy, and compliance practices.

* Ensures all demographic and insurance information is obtained and correct, and scans IDs and insurance cards, as needed. Sends query for insurance eligibility information provided by the patient and/or representative to validate eligibility and benefit information and accurately document in the registration system. Informs patient of insurance in/out of network status, as appropriate. Accurately completes the Medicare Secondary Payer Questionnaire on all Medicare eligible patients.

* Verifies insurance information through payor contact via telephone, online resources, or electronic verification system.

* Responsible for verifying diagnosis codes and completing medical necessity checks for Medicare. The Patient Access Associate I must have basic knowledge of ICD-10 in order to ensure accurate diagnosis entry for reimbursement.

* Identifies and obtains payor authorizations, pre-certifications, and/or referrals. Provides appropriate documentation and follow up to physician offices, case management department, and payors regarding authorization/referral deficiencies. Responsible for communicating to service line partners of situations where rescheduling is necessary due to lack of authorization and/or limited benefits and is approved by clinical personnel.

* In working inpatient accounts, is held responsible for timely notification to payers of the patient's admission to the facility.

* Identifies all patient financial responsibilities, calculates estimates, collects all payments due, including current estimated liabilities, outstanding balances and self-pay deposits, posts payment transactions in the system and performs daily reconciliation. Identifies self-pay and complex liability calculations and escalates account to Financial Counselors as appropriate. Responsible for all estimates requested for consumer shopper comparison.

* Appropriately collects and/or sets payment arrangements with patients of their representative, scheduling payments on deposits due, which may include screening of patients for enrollment in available credit option programs. Documents all attempts for collections, using approved verbiage, timely, and consistently. Proactively seeks assistance to improve collections.

* Ensures all patients with questions or concerns regarding their bills are referred to the appropriate resource, to include initiation of financial counseling, when appropriate.

* Documents pertinent activity on the patient account via notes.

* Responsible for patient throughput, established wait times and turnaround (TAT) times for all Patient Access areas along with aiding in the achievement of top box customer service scores for each respective Patient Access site.

* Maintains a current and thorough knowledge of utilizing online and system tools available, working from manual reports during system downtime.

* The Patient Access Associate I communicates and collaborates with Patient Access team members and other ancillary departments as needed.

* Attends all required trainings and in-services and passes all competency tests associated with the in-services.

* May be responsible for additional duties as assigned with respect to the Patient Access job scope.

QUALIFICATIONS

EDUCATION AND EXPERIENCE:

* High school diploma or equivalent required.

* 0-1 year experience in Healthcare registration or relevant customer service environment required.

* Previous experience in a physicians' office or hospital setting is preferred.

* The Patient Access Associate I can perform job duties based on department procedure and protocol; may require direct oversight

LICENSE/CERTIFICATION:

KNOWLEDGE AND SKILLS:

* Ability to communicate effectively both verbally and in writing sufficient to perform the essential functions; read, understand, and apply policies and guidelines; obtain information from a variety of sources is required.

* Knowledge of general computer and data entry functions required.

* Excellent communication, customer service, organizational and analytical skills required.

* Ability to prioritize and manage multiple tasks simultaneously, and to effectively anticipate and respond to issues as needed in a dynamic work environment. Ability to keep up in very fast paced environment required.

* Candidates must continuously display professionalism, courtesy and respect to all customers that always mirror AtlantiCare's Values/Behaviors.

* Candidate must have reliable means of transportation.

* Bilingual preferred.

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PERFORMANCE EXPECTATIONS

* Demonstrates the competencies as established on the Assessment and Evaluation Tool for this position.

* Must pass annual recertification with score of 95% or better. This requirement is expected to be maintained every year. Staff member will be required to re-take training and exam until they obtain the appropriate grade or disciplinary action will be taken in regards for performance.

* Maintains a high accuracy rate of 98% or higher and established productivity rates for Key Performance Indicators (KPI) such as cash collections wait and TAT times, pre-registration and registration productivity.

* Must achieve an evaluation rating of Valued Contributor or above on their annual evaluation the year of consideration and every year after, with no written disciplinary documents on file, to progress within Patient Access Levels. If the Valued Contributor rating is not achieved in the following years, an action plan will be put in place to remediate the staff member back to Valued Contributor.

* To advance via the Patient Access Career Path, the Patient Access Associate I must complete the coursework and Litmos Revenue Cycle Certified Professional I or Healthcare Financial Management Association -HFMA (CRCR) Certified Revenue Cycle Representative certification.

* The Patient Access Associate has the opportunity for advancement to Patient Access Associate II if all of the above requirements are satisfied and the Patient Access Associate has been in the role for one year.

WORK ENVIRONMENT

* Potential for exposure to the hazards and risk of the hospital environment, including exposure to infectious disease, hazardous substances, and potential injury.

* This position requires reaching, stooping, kneeling, and crouching approximately 25% of the workday. This position requires frequently lifting, approximately 25-30 pounds, and occasional lifting of 50-100 pounds with assistance. This position also requires pushing and pulling computers on wheels approximately up to 100% of the day if assigned to the Emergency Department or Labor and Delivery. High volume fast-paced environment.

* High volume fast-paced environment.

* The essential functions for this position are listed on the Assessment and Evaluation Tool.

REPORTING RELATIONSHIP

* This position reports to department leadership.

The above statement reflects the general details considered necessary to describe the principle functions of the job as identified and shall not be considered as a detailed description of all work requirements that may be inherent in the position.

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled