Authorization & Coverage Verification

The Patient Access Representative 1 (PAR1) is responsible for accurately registering inpatients, outpatients, and/or ER patients in the EMR, including validating patient information, verification of insurance coverage, calculation of and collection of patient co-insurance/deductibles/co-pays, authorization for services, and balancing of cash. the PAR1 ensures the patient's experience is best in class and demonstrates effective communication skills with patients and families, physicians, nurses, and insurance companies. The PAR1 is knowledgeable of and compliant with federal and state regulations related to acute-care patient registration.

Responsibilities

• Registration
• Effectively meets customer needs, builds productive customer relationships, and takes responsibility for customer satisfaction and loyalty. Represents the Patient Access department in a professional, courteous manner at ALL times. Asks patients if they may have special needs. Calls patients by name, Greets patients in a courteous and professional manner. Prioritizes and completes registration in a consistent, courteous, professional, accurate and timely manner.
• Obtains necessary information from patient, including demographic information, insurance, guarantor, and correctly inputs it into registration software. If patient is already in the system, finds correct patient record and verifies information in the system.
• Uses critical thinking skills to evaluate each registration situation to ensure customized registration experience based on individual patient circumstances. Uses knowledge of federal and state laws (EMTALA, HIPAA, Balanced Billing Act, Participating Provider statute, HITECH law, worker's compensation regulations, victims of sexually-oriented criminal offenses regulation, 2 midnight rules, ABN's, Patient status requirements, MSPs, and state regulations on notification of out-of-network status) to ensure compliant registration
• Ensures each patient is assigned only one medical record number.
• Communicates the purpose of and obtains patient/legal guardian signatures on all necessary hospital documents such as Hospital consent forms, assignment of benefits, patient rights, etc.
• Extensively documents each encounter in account notes to ensure successful cross-function communication.
• Ensures orders are received and are consistent with tests/procedures.
• Monitors the waiting room, facilitates patient flow, and resolves issues regarding orders or missing/conflicting information, to ensure timely and accurate patient registration.
• Insurance and Benefits Knowledge
• Demonstrates knowledge of insurance plans, including understanding of varying payer rules and requirements related to insurance coverage and prior authorization
• Verifies eligibility (utilizing online eligibility software tools whenever possible) and obtains necessary authorizations for services rendered.
• Selects correct insurance plans in the registration software, in the correct order (primary versus secondary).
• Has understanding of required forms (including Medicare Secondary Payer Questionnaire) and has ability to explain them to the patient.
• Utilizes payment estimator software to calculate patient financial responsibility. Uses critical thinking skills to determine correct data input during the estimate process and to verify accuracy of output.
• Determines when patients may be eligible for financial assistance and directs patients to appropriate resources.
• Financial Collections
• Uses proven customer service techniques and scripting to collect the patient financial obligation, at or before the time of service. Negotiates with patient to ensure a deposit is collected, in accordance with corporate policy and procedure.
• Understands and explains the details of the out-of-pocket calculation.
• Analyzes documentation/notes on current and previous accounts in order to explain balances to the patient.
• Demonstrates knowledge and ability to complete account acknowledgement forms when appropriate.
• Collects cash, prints receipts, and balances cash drawers.
• Other Duties as Assigned
• Performs all other duties as assigned.

Qualifications Education: High School diploma or equivalent.

Experience: 1 year customer service experience or related certification (e.g. Certified Coder, Certified Medical Assistant) substitutes for 1 year of experience.