Patient Access Representative

Underthe general supervision of the Supervisor, and according to establishedpolicies and procedures, interviews and registers all patients (Inpatient andObservation, Emergency, and Outpatients) to obtain demographic, third partyinsurance and related financial information, and enters to on-line computersystem. Initiates, reviews and follows-up on patient accounts to ensure properdata collection for billing. Verifies alldemographic and insurance information and obtains referrals as required.Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include:Instill Trust and Value DifferencesPatient and Community Focus and CollaborateRESPONSIBILITIES:Greetsand directs all patients, families and visitors in a prompt and courteousmanner.Interviews patient or patient's representative in order toobtain complete and accurate third party health insurance and relatedpersonal/financial information. Follows-up on missing data by interviewing patients, families or callingemployers, nursing homes and other facilitiesCompletes registration and enters all data obtained intohospital computer system. Prepares orcompletes records as follows:Ensures patient is properly identified in system perdepartment policy. Verifies demographicand insurance information by asking open-ended questions.Registers all patients (Outpatient, ED, Inpatient andObservation) by entering and/or verifying demographic insurance informationinto hospital information system. Upgrades account to an active account status.Completes documentation required on financial clearancereports as indicated by Patient Advocate or Pre-Registration Office.Utilizes on line tools and/or telephone to verify coverage,determine level of benefits, and confirm that the primary care physician (PCP)matches the PCP that is recorded in hospital system. Contacts insurance carrier or company formissing information when necessary. Notifies Pre-Registration Office if coverage changes frompre-admit/pre-registration information.Identifies primary and secondary insurer. Properly recordsinsurance information in system. Completes lien forms upon determination that aliability exists. Enter financial notesinto system.Gathers paper referrals from patients, when required by thepayer. Updates with the appropriate documentation. Contacts FinancialCounselor/Pre-Registration Office if the insurance does not verify or if thepatient does not have a referral when required by the payer.Utilizes system to determine self-pay balances for allpatients.Uses reference tools to determine the expected payment dueat time of service. Contacts Patient Financial Advocate to estimate expectedpayment on complex cases. Refers patients to Patient Financial Advocates ifpatients cannot meet the expected payment according to defined criteria.Collects co-payments as required per financial clearance oras required by third party payor or department policy. This includes cash;check, credit card payments for ambulatory and Emergency services or asindicated by Patient Advocates. Documents collections in system, logs payments, provides receipts perdepartment policy. Completes financialclearance screens in system.Explains consent, financial and insurance forms to patientsor designee and provides general hospital information regarding policy andprocedure. Obtains patient signatures onall required forms to meet established hospital requirements. i.e. Privacynotice, Patient Agreement, Important Message from Medicare/Tricare, theMedicare Observation Notice/Moon.Verifies and updates all information. Makes bracelets, places bracelet on patientsper department policies in accordance with patient identification policy.Utilizes hospital department scheduling and workflow reportsto complete daily work. Communicateswith service departments to obtain order information as required. Communicates with FinancialCounselor/Pre-Registration Office to obtain authorizations not obtained at, orprior to, time of serviceAsks patient for Advance Directive and includes withadmission paperwork to go to nursing unit, provides patients with informationon Advance Directives if one is not prepared.Explains and has patient sign Advance Beneficiary Notice(ABN) as required.Completesmedical necessity checks utilizing order entry system per hospital policy ifnot done during pre-registration process.Distributes financial aid applications when patient lacksevidence of adequate health insurance coverage, according to establishedcriteria. Refers patients to PatientFinancial Advocate to assist patient with applications for medical coverage(Medicaid, RIte Care, etc.) or Community Free Service, and to establish paymentplans.May pre-admit/pre-register, scheduled outpatients andinpatients, in hospital system.Contacts patient's to verify demographics obtained at timeof scheduling to complete any missing information.Verifies patient insurance coverage(s), both primary andsecondary, on-line or by telephone.Obtains and verifies all other information required tosecure payment through sources such as Worker's Compensation, MSP, Medicareliability, liens, etc.Ensures referrals are obtained and confirms accuracy of thePCP.Establishes level of insurance benefits and expected paymentfor selected services. Determines thepatient's portion of payment, when applicable and arrange for payment prior tothe provision of services.Checks outstanding balances incurred for previous servicesprior to contacting patient and follow collection policy concerning prepaymentprior to the provision of additional services.When appropriate, medical necessity verifications forservices to be provided will be performed by the servicing department and willalso require that ABN's be addressed for payment at the time ofpre-registration.May collect prepayments by phone or mail, if there is enoughtime before admission or the provision of outpatient services to accomplish thecollection, otherwise, instruct patient to bring payment at the time ofadmissionrrival.Refers insured patients who cannot meet their financialobligations including previously incurred hospital balances, currentadmission/outpatient expected non-covered charges and ABN's to PatientFinancial Advocates (in accordance with department policy).Updates status of financial clearance activities in system.Preparesssembles all necessary paperwork preparatory tothe patient's arrival.Reviews/corrects third party payer eligibility reports.Completes real time status transfers.At arrival, at admission or in the patient's room, maycomplete any missing documentation and paperwork required from patients and/orfamily membersCoordinates with Nursing Department to assign patient bedsin accordance with case management guidelines.Reviews newly assigned medical record numbers forduplication, reporting all duplicates on appropriate form.Attends and participates in staff meetings.May be required as needed to provide coverage to numerouslocations (hospital-based Admitting, ED, Outpatient and Pre-reg areas to meetpatient/customer needs.Protects and preserves patients right to privacy andconfidentiality.Utilizes department equipment: i.e. fax machine, phone, visamachine, laptop PC and other technology as developed.Performs other related duties as required to support theoperations of the Department.MINIMUM QUALIFICATIONS:BASIC KNOWLEDGE:High school diploma or equivalent. Knowledge of medical terminology, third partyinsurance information and standard office computer applications required. Knowledge of third party payer, verification,and authorization process preferred. Typing and data entry skills required.EXPERIENCE:Customer Service SkillsSix to twelve months previous third party billing orhospital registration experience. Thirdparty billing knowledge. Data entryskills and PC experience required.WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:Sitting for long periods of time at a workstation requiringthe continuous use of a computer and telephone. May have to do moderate to excessive walking, depending on the locationof the assignment. Ability to lift up to10 pounds.INDEPENDENT ACTION:Perform independently within department policies andpractices. Refer specific complexproblems to supervisor where clarification of departmental policies andprocedures may be required.

Pay Range:

-

EEO Statement:

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

Location:

Newport Hospital - 11 Friendship Street Newport, Rhode Island 02840

Work Type:

3p-7pm every other weekend and holidays

Work Shift:

Day

Daily Hours:

4 hours

Driving Required:

No