Patient Access / Pre-Access Representatives facilitate a welcome and easy access to the facility and are responsible for establishing an encounter for any patient who meets the guidelines for hospital service. Patient Access / Pre-Access staff ensures that all data entry is accurate including demographic and financial information for each account. Patient Access / Pre-Access has numerous procedural requirements including data elements, insurance verification, authorization for services, collections for all patient portions including prior balances and balancing of cash at shift end. Patient Access / Pre-Access staff is responsible for the successful financial outcome of all patient services. Patient Access / Pre-Access communicate directly with patients and families, physicians, nurses, insurance companies and third party payers. This position requires professional appearance, behavior, and good communication skills. Patient Access / Pre-Access representatives require dependability, flexibility, and teamwork.
REGISTRATION / SCHEDULING
Obtains and accurately inputs all required data elements for scheduling and registration, including patient demographic, financial information, guarantor information, and relevant notes associated with the encounter.
Data fields include but are not limited to: address, employment, insurance info, nearest relative, guarantor, insurance plan, admitting diagnosis, working diagnosis, and physician information.
Prioritizes and completes registrations / scheduling in a consistent, courteous, professional, accurate and timely manner.
Ensures each patient is assigned only one medical record number.
Selects appropriate patient type based on the department and services required.
Communicates the purpose of and obtains patient/legal guardian signatures on all necessary hospital documents. Knowledgeable of all such documents.
Hospital consent forms
Assignment of benefits
Payroll Deduction Form
Acknowledgement of Account
Financial Assistance Application
Living Will (& inquires if Living Will exists)
Advance Directive. (Obtains information from all patients over 18 years of age, and provides written information to patient when requested.)
Documents in account notes.
Ensures orders are received and are consistent with tests/procedures.
Prepares account/patient folder with necessary forms completed and signed.
Gives patient documents that he/she needs to take with him/her to other departments.
Insurance Verification / Explanation of Benefits
Verifies eligibility and obtains necessary authorizations for services rendered.
Medicare / Medicaid eligibility information through the patient admission process.
Answer Medicare Secondary Payer Questionnaire.
Utilizes online eligibility or Medifax when necessary for verification of Medicare / Medicaid
Obtains online verification of major payers, including Blue Cross (I-Link Blue), State Employees Group Benefit, Tricare, United Healthcare, and others.
Utilizes appropriate spreadsheets and worksheets to calculate patient financial responsibility.
Performs financial assessment for appropriate program assistance.
Utilizes appropriate guidelines to assist patient with financial responsibility.
Demonstrates accuracy in selecting insurance plans (I-plans).
Calculates and collects the estimated patient portion based on benefits and contract reimbursement as well as prior balances.
Utilizes appropriate language and behavior to collect patient financial responsibility.
Collect co-payments, deductibles, deposits and /or amounts due on previous accounts.
Knowledge and ability to review notes on all pre-admitted accounts and discuss with customer in a courteous professional manner
Knowledge of insurance plans
Knowledge and ability to review and explain previous accounts
Knowledge and ability to complete payroll deduction forms, account acknowledgement forms when appropriate
Writes or prints receipts and balances cash drawers.
Effectively meets customer needs, builds productive customer relationships, and takes responsibility for customer satisfaction and loyalty.
Greets patients in a courteous and professional manner.
Calls patients by name.
Asks patients if they may have special needs.
Represents the Patient Access / Pre-Access department in a professional, courteous manner at ALL times.
Makes minimal errors in performing admissions / scheduling / insurance verification / pre-registration. See Error Policy and Procedure for target error rate percentage.
Utilizes education information to reduce error rates.
Requests additional education information when necessary.
Demonstrates ability to select correct insurance plans.
Required to assist the hospital in the event of an internal or external disaster.
Supports the flexible needs of the department to accommodate patient volume in all areas of the hospital. This may require assignment to another area of the department, and shift change.
Supports the department in achieving established performance targets.
Completes required training as needed.
Performs all other duties as assigned.
Demonstrates reliability and dependability by reporting to work when scheduled.