Patient Access Representative

About This Role

This role involves interviewing and registering patients across various hospital services, including inpatient, observation, emergency, and outpatient. It suits someone who can accurately gather demographic, insurance, and financial information and ensure proper data collection for billing purposes, all while upholding the organization's values of Compassion, Accountability, Respect, and Excellence.

Responsibilities

• Greet and direct all patients, families, and visitors promptly and courteously
• Interview patients or their representatives to obtain complete and accurate third-party health insurance and related personal/financial information
• Follow-up on missing data by interviewing patients, families, or calling employers, nursing homes, and other facilities
• Complete registration and enter all data obtained into the hospital computer system
• Ensure patients are properly identified in the system per department policy
• Verify demographic and insurance information by asking open-ended questions
• Register all patients (Outpatient, ED, Inpatient, and Observation) by entering and/or verifying demographic insurance information into the hospital information system
• Upgrade accounts to an active account status
• Complete documentation required on financial clearance reports as indicated by the Patient Advocate or Pre-Registration Office
• Utilize online tools and/or telephone to verify coverage, determine level of benefits, and confirm that the primary care physician (PCP) matches the PCP recorded in the hospital system
• Contact insurance carriers or companies for missing information when necessary
• Notify the Pre-Registration Office if coverage changes from pre-admit/pre-registration information
• Identify primary and secondary insurers and properly record insurance information in the system
• Complete lien forms upon determination that a liability exists
• Enter financial notes into the system
• Gather paper referrals from patients, when required by the payer, and update with appropriate documentation
• Contact Financial Counselor/Pre-Registration Office if insurance does not verify or if the patient does not have a referral when required by the payer
• Utilize the system to determine self-pay balances for all patients
• Use reference tools to determine the expected payment due at time of service
• Contact Patient Financial Advocate to estimate expected payment on complex cases
• Refer patients to Patient Financial Advocates if patients cannot meet the expected payment according to defined criteria
• Collect co-payments as required per financial clearance or by third-party payor or department policy, including cash, check, and credit card payments for ambulatory and Emergency services or as indicated by Patient Advocates
• Document collections in the system, log payments, and provide receipts per department policy
• Complete financial clearance screens in the system
• Explain consent, financial, and insurance forms to patients or designees and provide general hospital information regarding policy and procedure
• Obtain patient signatures on all required forms to meet established hospital requirements, such as Privacy notice, Patient Agreement, Important Message from Medicare/Tricare, and the Medicare Observation Notice/Moon
• Verify and update all information
• Make bracelets and place them on patients per department policies in accordance with patient identification policy
• Utilize hospital department scheduling and workflow reports to complete daily work
• Communicate with service departments to obtain order information as required
• Communicate with Financial Counselor/Pre-Registration Office to obtain authorizations not obtained at, or prior to, time of service
• Ask patients for Advance Directives and include with admission paperwork to go to the nursing unit; provide patients with information on Advance Directives if one is not prepared
• Explain and have patients sign Advance Beneficiary Notices (ABN) as required
• Complete medical necessity checks utilizing the order entry system per hospital policy if not done during the pre-registration process
• Distribute financial aid applications when patients lack evidence of adequate health insurance coverage, according to established criteria
• Refer patients to Patient Financial Advocate to assist with applications for medical coverage (Medicaid, RIte Care, etc.) or Community Free Service, and to establish payment plans
• May pre-admit/pre-register scheduled outpatients and inpatients in the hospital system
• Contact patients to verify demographics obtained at the time of scheduling to complete any missing information
• Verify patient insurance coverage(s), both primary and secondary, online or by telephone
• Obtain and verify all other information required to secure payment through sources such as Worker's Compensation, MSP, Medicare liability, liens, etc.
• Ensure referrals are obtained and confirm accuracy of the PCP
• Establish level of insurance benefits and expected payment for selected services
• Determine the patient's portion of payment, when applicable, and arrange for payment prior to the provision of services
• Check outstanding balances incurred for previous services prior to contacting patients and follow collection policy concerning prepayment prior to the provision of additional services
• Perform medical necessity verifications for services to be provided by the servicing department and address ABNs for payment at the time of pre-registration, when appropriate
• May collect prepayments by phone or mail if there is enough time before admission or the provision of outpatient services
• Refer insured patients who cannot meet their financial obligations, including previously incurred hospital balances, current admission/outpatient expected non-covered charges, and ABNs, to Patient Financial Advocates (in accordance with department policy)
• Update status of financial clearance activities in the system
• Prepare and assemble all necessary paperwork preparatory to the patient's arrival
• Review/correct third-party payer eligibility reports
• Complete real-time status transfers
• At arrival, at admission, or in the patient's room, may complete any missing documentation and paperwork required from patients and/or family members
• Coordinate with the Nursing Department to assign patient beds in accordance with case management guidelines
• Review newly assigned medical record numbers for duplication, reporting all duplicates on the appropriate form
• Attend and participate in staff meetings
• May be required to provide coverage to numerous locations (hospital-based Admitting, ED, Outpatient, and Pre-reg areas) to meet patient/customer needs
• Protect and preserve patients' right to privacy and confidentiality
• Utilize department equipment such as fax machine, phone, visa machine, laptop PC, and other developed technology
• Perform other related duties as required to support the operations of the Department

Requirements

• High school diploma or equivalent
• Knowledge of medical terminology, third-party insurance information, and standard office computer applications
• Typing and data entry skills

Nice to have:

• Knowledge of third-party payer, verification, and authorization process
• Six to twelve months of previous third-party billing or hospital registration experience
• Third-party billing knowledge
• PC experience

Important Details

• Schedule: every other weekend, every Thursday, and every Friday
• Daily Hours: 8 hours
• Driving Required: No

About the Company

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment. Employees are expected to role model the organization's values of Compassion, Accountability, Respect, and Excellence, which guide everyday actions with patients, customers, and one another. All employees are also expected to demonstrate core Success Factors, including Instill Trust and Value Differences, Patient and Community Focus, and Collaborate.