PATIENT ACCESS ASSOCIATE - A NOMC ADMISSIONS
Status: Full Time
Shift: Days - Hours Vary
To provide excellent customer service during the patient access/intake process according to established hospital procedures.The Patient Access Associate (PAA) executes patient access through the continuum of the revenue cycle that supports patient safety, efficiency, cost reduction and service improvement.Patient Access includes the patient’s pre-encounter, encounter and post-encounter which include accurate and efficient patient registration, insurance verification, scheduling, and pre-service collections in compliance with payer and facility rules and regulations.
High School Diploma is required.
One year of previous experience in healthcare field or customer service required. College degree can be substituted for experience.
Experience in healthcare admissions, registration, or billing preferred.
Medical Terminology desired
Ability to communicate over the telephone
Excellent customer service skills.
Must be able to interpret complex documents related to insurance benefits.
Must be able to read and understand required components of physician’s orders.
Requires judgement to accurately establish patient identity, assign insurance information according to payer and facility guidelines, associate orders with scheduled services, and transcribe physician orders.
Intermediate computer skills required; ability to operate a computer using Word, Excel, and email, fax machines, printers, and copiers.
ED Physical Demand Exceptions::
The PAA assists patient and visitors as needed to ensure timely access to medical services.
The PAA works effectively to ensure the highest regard to customer service is given to every patient, customer, practitioner’s office, and every department that utilizes the Patient Access department.
The PAA ensures timely and safe access to medical care by completing patient scheduling, insurance verification, and registration processes in an efficient, accurate and timely manner and according to department guidelines.
The PAA supports the Patient Access Department role in the revenue cycle by scheduling according to physician orders, reviewing insurance documents verifying coverage, updating all insurance information in the patient’s registration, estimating financial responsibility andcollecting payments according to the Patient Access and Hospital policies and procedures.
The PAA ensures legal compliance, patient safety, and system financial integrity by performing state license verification, sanction and exclusion verification as well as NPI verification on all providers not already listed in the hospital information system.
The PAA, during registration, communicates the purpose of and secures patient signatures as required by department procedures on documents including, but not limited to, Conditions of Treatment form, Notice of Privacy Practices (HIPAA), Advanced Directives, Patient Rights, Important Message from Medicare (IMM), Medicare Secondary Payer (MSPQ), ABN, Financial Disclosure and any other facility required forms or documents required to meet JCAHO, CMS, and DHH requirements.
The PAAcontacts patients and provider offices by phone using excellent customer service to obtain patient for reasons including, but not limited to demographic and insurance information,schedule ordered services, provide financial responsibility information in order to support timely and accurate billing of all payers.
Performs insurance verification and authorization/pre-certification processes (including but not limited to careful review of the Real Time Eligibility system as well as clear communication with insurance company representatives) for all NOMC patients according to the Patient Access Department guidelines.
The PAA demonstrates basic knowledge of payer types including, but not limited to, Commercial, Medicare, Medicaid, Other Governmental, Worker’s compensation, Managed care, and Self-pay in order to scheduler, verify coverage, secure authorization, provide notification, and register patients according to department procedures and payer requirements.
The PAA demonstrates verbal understanding of basic terminology as it relates to insurance guidelines including but not limited to Co-payment, Co-insurance, Deductible, Allowable/Allowed amount, Payable Rates, Payer Notification, Pre-Certification, Prior Authorization, Guarantor, Primary/Secondary/Tertiary Coverage, and Explanation of Benefits.
The PAA recognizes diagnosis and CPT codes as necessary to complete scheduling, registration, insurance verification, authorization, notification, price estimates and order transcription as assigned.
When required by role assignment, the PAA ensures Emergency Medical Treatment and Labor Act (EMTALA) compliance, by registering patients according to department/hospital guidelines.
The PAA documents in appointment and/or account notes as well as any appropriate comment fields as instructed any issues related scheduling, insurance verification or registration of the patient.
The PAA interacts with relevant departments including but not limited to Ancillary departments, Revenue Integrity, Financial Services, Information Technology, Health Information Management, Case Management to problem solve and coordinate any concerns related to patient identification, registration, scheduling, insurance verification, or billing issues.
The PAA assists in patient conflict resolution to ensure timely access to care as well as to facilitate a positive patient experience.
The PAA when assigned resolve hospital account errors and claim edits timely and accurately to facilitate to support the facility’s financial goals.
The PAA complies with all Patient Access Department and hospital safety, environmental and infection control policies and procedures as well as the hospital objectives and quality assurance programs.
The PAA follows North Oaks Health System’s Compliance Program and Federal and State Regulatory Guidelines.
The PAA enhances professional growth by participating in education programs and department meetings as required.
The PAA provides back up to the Patient Access Assistant as needed.
The PAA performs all duties as directed by the Patient Access Department Supervisor, Manager, and Director/Designee.
Provides assistance, guidance, and directions to visitors, patients, employees, vendors and physicians. Secures escort or directs patient to the appropriate service area.
Ensures that patients are in the appropriate area for registration, directing patients needing to go to other areas with instructions.
Maintains competency in Service Recovery utilizing AAA (refer to polies and procedures). A – Acknowledge A – Apologize A – Amend Maintains personal appearance following the department and facility’s dress code.
Maintains the appearance of the waiting/lobby area.
Calls housekeeping when necessary.
Establishes effective relationships with co-workers in own department as well as other departments.
Assists others and shows willingness to work as a team player.
Performs appropriately in difficult situations by remaining calm, notifying appropriate personnel, and initiating appropriate action.
Responds to inquiries from patients, relatives, physicians, insurance companies and the general public quickly and efficiently by actively listening and taking appropriate action.
Discusses problems and/or confidential information only in appropriate setting and only with appropriate personnel.
Keeps any confidential documents secure and out of the public view.
Maintains par level of supplies and communicates to immediate supervisor when supplies are needed.
Ensures all equipment is functional and ready for service, including paper levels in copiers, printers, and fax machines and reports to the supervisor as needed.
When identified, removes and labels broken equipment or furniture from patient and visitor areas and notifies a supervisor.
Immediately notifies the appropriate department to remove item and/or fix broken item.
Calls for all other service repairs as need is identified.
Utilizes the 4 Cs in all interactions