Patient Access Representative 2 Full Time Bascom Palmer Eye Institute Miami, FL

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The University of Miami, Bascom Palmer Eye Institute, has an exciting full time opportunity for a Patient Access Representative 2 in Miami, Florida.

The Patient Access Representative 2 (On-Site) registers patients for clinical services by obtaining pertinent information, verifying insurance benefits, explaining pertinent documents, and collecting payments

CORE JOB FUNCTIONS

• •Obtains, confirms, and enters demographic, financial, and clinical information necessary for financial
• •clearance of scheduled patient accounts.
• •Contacts patients’ families or physicians’ offices to obtain missing insurance information.
• •Verifies insurance and confirms insurance eligibility of patient coverage benefits, notifying patient and
• •referring physician in the event of failed eligibility.
• •Collaborates with scheduling departments to identify add-on patients.
• •Obtains necessary authorizations, pre-certifications, and referrals.
• •Notifies patients of liabilities and collects funds.
• •Maintains appropriate records, files, and accurate documentation in the system of record.
• •Adheres to University and unit-level policies and procedures and safeguards University assets.

This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.

CORE QUALIFICATIONS

Education:

High School Diploma or equivalent/relevant experience, certification or license

Experience:

Minimum 2 years of relevant experience required

Commitment to Service Excellence

Serve as Patient Advocate and Service Ambassador by providing a favorable first impression and proactive attention to internal and external customers in order to meet or exceed expectations, address concerns, and optimize experience.

• •Project a professional appearance and demeanor including appropriate body language and vocal tone.
• •Immediately recognize and acknowledge internal and external customers in a welcoming, courteous and professional manner.
• •Respect the privacy, dignity and confidentiality of our patients and be responsive to their needs by showing concern, empathy, patience and respect.
• •Maintain composure during stressful situations and use sound judgment.
• •Provide immediate service recovery by taking ownership of any problems that may arise and resolving them utilizing appropriate rationale.
• •Provide patients with and interpret Patient Rights and Responsibilities.
• •Reduce patient and family stress and increase patient satisfaction by actively participating in providing the best possible patient experience.

2. Scheduling

Coordinate scheduling of all walk in, add on, and follow up appointments in accordance with established guidelines and in multiple systems, i.e. UChart Cadence/Prelude/Enterprise Billing, UMCare, and RIS/PAC.

Enter and/or update all pertinent data including demographics, financial, and referring physician information.

• •Interact with patients and collaborate with providers and clinicians to appropriately schedule appointments taking into account scheduling guidelines per division/specialty/provider, resource availability, special needs, timeframes, medical necessity, and payer and contractual guidelines.
• •Determine appointment type and utilize analytical skills to determine appropriate slot utilization and instances when overbooking is appropriate.
• •Obtain and document pertinent insurance verification information (i.e. CPT codes, service description, reason for visit, etc.) needed to obtain authorization/pre-cert in order to avoid denials and ensure financial reimbursement.
• •Coordinate multiple appointments with appropriate sequence and proper time allotted between appointments.
• •Communicate to patient the place of service where each appointment will take place (i.e. POS 11 vs. 22) and how it may impact his/her financial responsibility.

3. Ancillary/Clinic Support Services

Perform ancillary/clinic support duties which vary by hospital departments and specialties (i.e. ER, Admitting, CTU, Imaging, Bariatrics, Dermatology, Infertility, Mental Health, OB GYN, Oral Surgery, Pediatrics, Plastic Surgery, etc.) that include but are not limited to the following:

• •UChart Office Assistant functions and monitoring of Provider’s In Basket Messaging
• •Processing of Back to Work or School Requests, and Immunization Records
• •Scanning Imaging Results
• •Preparing Charts/Medical Records
• •Processing of Medical Record Release of Information
• •Prescription Refill Requests
• •Test Results Requests
• •Treatment Plans
• •Appt. Reminder Calls
• •Bump Lists
• •Surgery Scheduling
• •Coordination of External Referrals
• •Promotion and Sales of Over the Counter Products
• •Inventory and Ordering of Supplies
• •Ordering of DME products
• •Bed Assignments
• •Pre-certifications

4. On-site Registration (Check in/Admission)

Perform all on-site patient access registration related functions promptly without compromising patient safety, quality, service levels, and reimbursement.

• •Obtain legal photo identification and (if applicable) insurance card (s), and validate patient identity and coverage (if applicable) prior to services being rendered thereby ensuring patient safety and financial reimbursement.
• •Scan ID, insurance card (s), advance directives, share of cost letters, and any other pertinent documents.

• •Obtain and/or verify that all demographic, financial, and insurance coverage information is accurate, up to date and complete, and that financial clearance has been obtained inclusive of all required referrals/authorizations.
• •Explain all applicable forms (i.e. Consent for Medical Treatment and Conditions of Admission, Acknowledgement of Receipt of Privacy Practices, Questionnaires, Important Message from Medicare, Advance Directives Checklist, and answer any questions patients’ may have pertaining to form(s) and established policies.
• •Obtain and witness all patient/guarantor signatures on all applicable consents and forms, and ensure that all initial and signature areas required have been completed and forms have been dated, timed and labeled.
• •Print out labels and/or any forms required by treatment area.
• •Complete check-in and registration process as rapidly as possible (without compromising quality or service level) in order to minimize the time patients must wait for treatment to begin.

5. Insurance Verification/Financial Clearance

Verify insurance eligibility, obtain all applicable referrals/authorizations/pre-certifications, and confirm that non-emergent visits have been financially cleared prior to services being rendered in order to ensure financial reimbursement.

• •Verify insurance eligibility and authorization requirements for walk-ins and add-ons utilizing multiple automated on-line resources or telephone.
• •Identify point of service (POS) 11 versus 22 and obtain verification and referral/authorization accordingly.
• •Provide patient/guarantor with detailed benefit and authorization requirements and co-pay, deductible, and co-insurance self–pay responsibility for POS 11 and 22.
• •Ensure that the appropriate payer has been selected (i.e. Indemnity, HMO, PPO, POS, Auto, W/C, etc.) and that all the required data elements and referrals and authorizations based on CPT, ICD 9, and services being rendered have been obtained and accurately entered in system in order to avoid claim rejections.
• •Refer non-contracted payers for single case negotiation.
• •Determine appropriate filing order if patient is covered by more than (1) payer.
• •Financially clear visits once insurance has been verified and referral/authorizations obtained.
• •Generate HAR (Hospital Account Record) for all services rendered at a point of service 22 (POS 22), and assigns H