HIM/PATIENT ACCESS REP

Job Summary

This position is responsible for Patient Access duties including, but not limited to appointment scheduling, pre-registration, registration, insurance verification, prior-authorization, telephone coverage, explains and obtains signatures on forms, up-front collections, registration follow-up, and customer service. In addition, this position is responsible for maintaining, preserving, and releasing confidential health records in accordance with specified state agency, federal requirements, and hospital policies and is accountable for performing clerical and administrative functions to support the main HIM Department and billing services for both the Clinic and Hospital.

Essential Functions – Level 1

Reaches Proficiency in:

• Registers patients by verifying identity and interviewing patients or representatives in a pleasant, professional, and timely manner according to department practices.
• Validates existing data related to prior registrations by asking patient to repeat all data and update appropriately in the EHR.
• Ensures all necessary demographic, guarantor, financial data, and emergency contacts are obtained and accurately entered into the Electronic Health Record (EHR).
• Enrolls the patient to the patient portal. Validates the email address.
• Selects the correct patient type and medical services.
• Scans all necessary insurance information, including insurance cards, personal identification, driver's license, physician order, etc. into EHR.
• Identifies appropriate payor sources and verifies eligibility by thoroughly reading the report generated in the EHR or online. Contacts health plan via telephone when electronic means of determination are not available.
• Notifies health plans when patients transition to Observation, Inpatient, or Swing when necessary.
• Completes timely Emergency Care Reporting to health plans requiring notification.
• Reviews and understands the insurance eligibility reports to determine patients' upfront costs.
• Refers all private pay, underinsured patients, and Hospital Presumptive Eligibility applications to the Financial Counselor.
• Answers and appropriately routes all incoming telephone calls.
• Performs cashier functions for all patients who present cash, check or credit card as