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Senior Patient Access Representative-Camp Verde

Overview
The Senior Patient Access Representative is responsible for the verification and collection of patient demographic and insurance information by direct data entry to the electronic medical record during the scheduling/pre-admit or registration process prior to discharge. S/he conducts an interview with the patient or authorized representative to secure information specific to requested services; accurately documenting the discussion and other registration/scheduling activities in the encounter. S/he is a knowledge resource for ancillary or clinical departments related to registration and financial education questions or issues.
Responsibilities
Patient Registration and Scheduling:
Demonstrates ability to navigate web-based products or system applications required for registration or scheduling.
Accurate identification of patient for direct data entry of required clinical, demographic, and insurance information to the electronic medical record during registration or for appointment booking of assigned diagnostic procedures.
Provides general explanation of scheduled procedures and patient instructions that are necessary for conducting diagnostic medical services.
Ensures system documentation specific to the patient visit is entered and accurately reflects activities related to patient or provider contact, order documentation, insurance verification, financial education, and payment.
Provides explanation of legal forms and secures signature of patient/authorized party as required for services.
Performs medical necessity checking for identified services and secures required ABN documentation as appropriate.
Demonstrates thorough understanding of compliance standards required within a healthcare environment including EMTALA and HIPAA-Privacy Patient Confidentiality regulations.
Insurance Verification:
Accurate identification and selection of insurance carrier in the patient medical record for specified dates of medical services.
Navigation of web-based products or system applications to initiate and document insurance eligibility, benefit details, and authorization requirements.
Performs required notifications to ensure insurance authorization for identified outpatient diagnostic or medical services, surgical procedures, and inpatient/observation stays are secured and documented.
Demonstrates advanced knowledge of CPT, ICD10 coding, and physician order requirements as required for medical services including determinations for medical necessity.
Financial Counseling:
Demonstrates advanced knowledge of regulatory or Third Party Payer insurance requirements including Medicare, AHCCCS/Medicaid, Workers Comp and other commercial payers.
Educates the patient on insurance eligibility, coverage, procedure costs, alternate resources for financial assistance, and payment arrangement guidelines.
Collects identified patient financial liabilities; performs secured payment entry and deposit/cash reconciliation steps.
Navigation of web based products to initiate, document, and provide charge estimation for diagnostic services based on patient requests or financial counseling needs.
Demonstrates advanced conflict resolution to address issues related to scheduling, registration or the financial education process.
Makes direct contact on behalf of the patient to providers, insurance representatives, or to outside agencies such as Arizona Department of Economic Security for initiation of the AHCCCS application process.
Revenue Cycle Support:
Performs PBX Switchboard functions as required for answering and routing of internal/external calls; paging codes and fire alarms; handles department call volumes as assigned to appropriately respond to requests from patients, providers, or other hospital departments.
Acts as a resource for clinical departments for registration/scheduled services related to data entry of patient account fields, provider order requirements, and questions regarding insurance coverage or financial assistance.
Coordinates information with Clinical departments or Care Management related to registration, financial counseling, or insurance coverage and benefit limits potentially affecting patient length of stay and discharge planning efforts.
Monitors and analyzes Revenue Cycle reports and system work lists to ensure accuracy of patient record and that all process steps, insurance requirements, and compliance standards have been met for scheduling, registration, and financial counseling activities.
Qualifications
Education:
High School Diploma or GED- Required
Associate's Degree- Preferred
Medical Terminology Coursework- Preferred
Experience:
Minimum 2 years in a customer service role- Required
Basic level of computer skills including keyboarding of 35wpm- Required
Minimum 2 years experience in a medical facility, health insurance, or related medical field-
Preferred
Proficiency in Microsoft applications (Excel, Word, PowerPoint)- Preferred
Call Required - within 30 mins.
Physicial Requirements: Standing - constantlySitting - constantlyWalking - constantly Lifting/Carrying up to 10lbs. - frequently Bending - occasionallyKneeling - occasionallyPushing/Pulling up to 25lbs. - occasionally Reaching Overhead - occasionally

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