Patient Access Rep PD

SUMMARY:

Under the general supervision of the Supervisor, and according to established policies and procedures, interviews and registers all patients (Inpatient and Observation, Emergency, and Outpatients) to obtain demographic, third party insurance and related financial information, and enters to on-line computer system. Initiates, reviews and follows-up on patient accounts to ensure proper data collection for billing. Verifies all demographic 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 Differences
• Patient and Community Focus and Collaborate

RESPONSIBILITIES:

Greets and directs all patients, families and visitors in a prompt and courteous manner.

Interviews patient or patient's representative in order to obtain complete and accurate third party health insurance and related personal/financial information.

Follows-up on missing data by interviewing patients, families or calling employers, nursing homes and other facilities

Completes registration and enters all data obtained into hospital computer system. Prepares or completes records as follows:

Ensures patient is properly identified in system per department policy. Verifies demographic and insurance information by asking open-ended questions.

Registers all patients (Outpatient, ED, Inpatient and Observation) by entering and/or verifying demographic insurance information into hospital information system. Upgrades account to an active account status.

Completes documentation required on financial clearance reports 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 for missing information when necessary. Notifies Pre-Registration Office if coverage changes from pre-admit/pre-registration information.

Identifies primary and secondary insurer. Properly records insurance information in system. Completes lien forms upon determination that a liability exists. Enter financial notes into system.

Gathers paper referrals from patients, when required by the payer. Updates with the appropriate documentation. Contacts Financial Counselor/Pre-Registration Office if the insurance does not verify or if the patient does not have a referral when required by the payer.

Utilizes system to determine self-pay balances for all patients.

Uses reference tools to determine the expected payment due at time of service. Contacts Patient Financial Advocate to estimate expected payment on complex cases. Refers patients to Patient Financial Advocates if patients cannot meet the expected payment according to defined criteria.

Collects co-payments as required per financial clearance or as required by third party payor or department policy. This includes cash; check, credit card payments for ambulatory and Emergency services or as indicated by Patient Advocates. Documents collections in system, logs payments, provides receipts per department policy. Completes financial clearance screens in system.

Explains consent, financial and insurance forms to patients or designee and provides general hospital information regarding policy and procedure. Obtains patient signatures on all required forms to meet established hospital requirements. i.e. Privacy notice, Patient Agreement, Important Message from Medicare/Tricare, the Medicare Observation Notice/Moon.

• Verifies and updates all information. Makes bracelets, places bracelet on patients per department policies in accordance with patient identification policy.
• Utilizes hospital department scheduling and workflow reports to complete daily work. Communicates with service departments to obtain order information as required. Communicates with Financial Counselor/Pre-Registration Office to obtain authorizations not obtained at, or prior to, time of service

Asks patient for Advance Directive and includes with admission paperwork to go to nursing unit, provides patients with information on Advance Directives if one is not prepared.

• Explains and has patient sign Advance Beneficiary Notice (ABN) as required.
• Completes medical necessity checks utilizing order entry system per hospital policy if not done during pre-registration process.

Distributes financial aid applications when patient lacks evidence of adequate health insurance coverage, according to established criteria. Refers patients to Patient Financial Advocate to assist patient with applications for medical coverage (Medicaid, RIte Care, etc.) or Community Free Service, and to establish payment plans.

• May pre-admit/pre-register, scheduled outpatients and inpatients, in hospital system.
• Contacts patient's to verify demographics obtained at time of scheduling to complete any missing information.

Verifies patient insurance coverage(s), both primary and secondary, on-line or by telephone.

• Obtains and verifies all other information required to secure payment through sources such as Worker's Compensation, MSP, Medicare liability, liens, etc.
• Ensures referrals are obtained and confirms accuracy of the PCP.

Establishes level of insurance benefits and expected payment for selected services. Determines the patient's portion of payment, when applicable and arrange for payment prior to the provision of services.

Checks outstanding balances incurred for previous services prior to contacting patient and follow collection policy concerning prepayment prior to the provision of additional services.

When appropriate, medical necessity verifications for services to be provided will be performed by the servicing department and will also require that ABN's be addressed for payment at the time of pre-registration.

May collect prepayments by phone or mail, if there is enough time before admission or the provision of outpatient services to accomplish the collection, otherwise, instruct patient to bring payment at the time of admission arrival.

Refers insured patients who cannot meet their financial obligations including previously incurred hospital balances, current admission/outpatient expected non-covered charges and ABN's to Patient Financial Advocates (in accordance with department policy).

Updates status of financial clearance activities in system.

• Preparesssembles all necessary paperwork preparatory to the 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, may complete any missing documentation and paperwork required from patients and/or family members
• Coordinates with Nursing Department to assign patient beds in accordance with case management guidelines.

Reviews newly assigned medical record numbers for duplication, reporting all duplicates on appropriate form.

Attends and participates in staff meetings.

May be required as needed to provide coverage to numerous locations (hospital-based Admitting, ED, Outpatient and Pre-reg areas to meet patient/customer needs.

• Protects and preserves patients right to privacy and confidentiality.
• Utilizes department equipment: i.e. fax machine, phone, visa machine, laptop PC and other technology as developed.

Performs other related duties as required to support the operations of the Department.

MINIMUM QUALIFICATIONS:

• BASIC KNOWLEDGE:
• High school diploma or equivalent. Knowledge of medical terminology, third party insurance information and standard office computer applications