PATIENT ACCESS & PRE SERVICES REP

US:NV:Carson City Central Scheduling

Per Diem Day Shift

Summary

Responsible for obtaining/validating appropriate authorizations and benefits are obtained for all scheduled services at all locations across the health system. Responsible for completing a thorough pre-registration process including communication with patient/guarantor related to upfront collection of copay/deductible and deposits. The population served by this position consists of the adult age group.

Qualifications

To perform this job successfully, an individual must be able to perform each essential function. Additionally, the specifications listed below are representative of the education, knowledge and skill required for this position.

• High school diploma or equivalent required.
• A minimum of three (3) years experience in a health care setting involving computerized patient registration &/or insurance verification / benefit responsibilities.
• Must be able to demonstrate a high level of computer skills including hospital intranet site as well as the internet as appropriate.
• Utilization review, medical terminology and working knowledge of Microsoft Office preferred.
• Clearly communicates both verbally and in writing.

Essential Functions

• Obtains / validates authorizations and benefits for all scheduled services at all locations across the health system within 3 working days before the date of service to meet standards for position. To exceed standards – 5 days before the date of service.
• Completes a thorough pre-registration process including communication with patient/guarantor related to upfront collection of copay/deductible and deposits. 97% accuracy will meet standard. 99% will exceed standard.
• Maintains a current working knowledge of medical necessity requirements & clinical quality guidelines for all health plans, ensuring that these have been met prior to service being provided. Meeting this standard requires a 95% accuracy rate. Exceeding standard – 98% accuracy.
• Through patient communication and documentation, ensures a 50% department success rate in collecting all identified patient share of cost for assigned patients.
• Follows hospital protocol for handling of uninsured patients including referral to eligibility vendor if appropriate.
• Regularly checks for add-ons throughout the day, ensuring appropriate approvals in place.
• Acts as facility liaison for patients requesting estimates for surgical or outpatient procedures.
• Ensures that appropriate follow up is made for length of stay authorizations for inpatient reporting
• Ensures the accuracy of all patient encounter information (demographics/insurance). 95% accuracy to meet standard. 98% accuracy rate to exceed standard.
• As requested, assists with denials for authorizations and reviews of payment accuracy based on payer / governmental contracts.
• Ensures all documentation is noted in ADT system.
• Demonstrates working knowledge of all hospital IT systems necessary to accomplish daily tasks.
• Assess and trouble shoots problems with patients, referring physicians and their staff. Independently makes decisions that fundamentally adhere to hospital and/or department protocols.
• Independently demonstrates ability to provide and facilitate excellent customer service in all situations.
• Acts as a mentor for new employees as they develop their skills and competencies related to daily job functions.
• Actively participates with all performance improvement initiatives – both departmental and organizationally, as requested.
• Demonstrates openness to new procedures and provides constructive recommendations to Supervisor(s).
• Attends no less than 75% of all department and/or organizational meetings.