Patient Access Representative 1 (On-Site) - Full Time Bascom Palmer Eye Institute - Miami. FL
Patient Access Representative 1 (On-Site) - Full Time Bascom Palmer Eye Institute - Miami. FL
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Job Description
Current Employees:
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The University of Miami Bascom Palmer Eye Institute has an exciting opportunity for a full time Patient Access Representative 1 (OnSite) in Miami Patient Access Representative 1 (OnSite) registers patients for clinical services by obtaining pertinent information verifying insurance benefits and collecting payments.
CORE JOB FUNCTIONS
Performs full registration and ensures that insurance is verified and all patients information is correct.
Obtains copies of insurance cards drivers license and any applicable referrals.
Explains Consent for Treatment Financial Liability and HIPAA to patients and obtains signed forms.
Instructs patients to complete any questionnaires that might be required by physician.
Schedules followup cancels and edits appointments and records noshow patients accurately.
Reconciles all vouchers and delivers them to designated area.
Answers telephone calls and responds to questions and inquiries or transfers when appropriate.
Adheres to University and unitlevel policies and procedures and safeguards University assets.
This list of duties and responsibilities is not intended to be allinclusive and may be expanded to include other duties or responsibilities as necessary.
CORE QUALIFICATIONS
Education:
High school diploma or equivalent
Experience:
Minimum 1 year of relevant experience
Knowledge Skills and Attitudes:
General knowledge of office procedures and operations.
Skill in data entry with minimal errors.
Ability to communicate effectively in both oral and written form.
Skill in completing assignments accurately and with attention to detail.
Ability to process and handle confidential information with discretion.
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.
Department Specific Functions
1.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/precert 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.
2.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 Providers 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
Precertifications
3.Onsite Registration (Check in/Admission)
Perform all onsite 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 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 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 have been completed and forms have been dated timed and labeled.
Print out labels and/or any forms by treatment area.
Complete checkin 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.
4.Insurance Verification/Financial Clearance
Verify insurance eligibility obtain all applicable referrals/authorizations/precertifications and confirm that nonemergent visits have been financially cleared prior to services being rendered in order to ensure financial reimbursement.
Verify insurance eligibility and authorization requirements for walkins and addons utilizing multiple automated online 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 copay deductible and coinsurance selfpay 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 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 noncontracted 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 HARs to appointments accordingly.
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5.Compliance
Comply and abide with all established UHealth policies and procedures related to Patient Access and State/ Federal regulations.
MSPQ
Complete the Medicare Secondary Payer Questionnaire (MSPQ) at time of scheduling prior to services being rendered and in accordance with Centers for Medicare & Medicaid Services (CMS) Federal regulations.
ABN
Utilize medical necessity software to determine if an Advance Beneficiary Notice (ABN) is applicable in order to produce and provide all Medicare patients with an ABN in accordance with CMS Federal regulations prior to services being rendered. Explain ABN in detail and allow patient to make an informed decision and document in system.
Study and Transplant
Identify patients enrolled in a Study/Transplant program and validate that the account reflects the appropriate coverage(s) as it relates to the Study/Transplant program in order to ensure accurate billing.
6. Collections
Identify and collect patients selfpay responsibility including copays deductibles coinsurances self pay discount rates global packages and previous outstanding balances for both technical and professional components in POS 11 and 22 clinics thereby playing a key role in reducing AR Bad Debt and Collection Costs by collecting patients financial responsibility upfront.
Exercise sound judgment so as not to delay treatment for emergency medical conditions and necessary stabilizing treatments due to patients financial responsibility and collection efforts.
Determine and collect patients estimated financial responsibility for both POS 22 and POS 11 (i.e. deductible copayment coinsurance prompt payment discounts or global fee based on CPT/ICD9 codes).
Explain charges fees and previous balances for both technical and professional components.
Offer forms of payment including cash checks and credit cards.
Check for counterfeit bills when collecting cash and obtain authorization for all credit card transactions.
Post payment(s) as applicable for both POS 11 and 22 and issue system generated receipt(s).
Reconcile all collections and transactions at the end of the shift including initial cash bag funds.
Prepare daily deposit(s) for Med Finance Main Cashier or contracted armored pick up service.
Document any and all collection details including discounts global fees and partial payments in system and select applicable billing indicators and FYI Global/Discount flags.
7.Financial Counseling
Provide upfront financial counseling services at time of checkin including identifying alternate funding resources and establishing payment plans.
Advise patients of financial obligations and collect according to established guidelines and financial policies.
Identify alternate funding sources and offer global or discount.
Identify patients which have been deemed eligible for charity care or financial hardship and determine if services being rendered are encompassed in charity approval.
Assist patients in establishing payment plans.
8.Discharge / Departure
Coordinate discharge process including identification and collection of additional selfpay charges prompt scheduling of all follow up appointments procedures diagnostic testing etc. appointment status update voucher/facility fee reconciliation and After Visit Summary (AVS).
Determine upon checkout/discharge any pending financial responsibility and collect and post payment(s) accordingly.
Systematically reflect the checkout/discharge status by carrying out the checkout function and updating the appointment status to complete.
Check discharge orders and coordinate the prompt scheduling of any and all follow up appointment(s)/procedure(s) diagnostic or ancillary services ordered.
Print and provide the patient with an After Visit Summary (AVS).
Obtain applicable vouchers facility fee and/or secondary forms and screen for accuracy.
9.Front End Revenue Cycle Quality Control
Comply with all standard operating procedures established to support key metrics and quality assurance initiatives that contribute toward prompt billing and increased cash flow.
Identify systematic warning flags/messages and populate data elements in order to eliminate by passed warnings/errors and avoid a negative impact on downstream revenue cycle processes.
Monitor and clear patient work queues on a daily basis to ensure data integrity prompt billing and minimal AR days.
Populate any and all data to ensure the checklist at the end of the arrival process reflects as complete for each category.
10.Charge Entry
Account for and enter accurate charges within established time frame.
Enter charge codes and amount of units accurately and within (1) business day of services being rendered.
Perform daily reconciliation to identify missing charges and follow up with clinicians to obtain in order to ensure all rendered services are accounted for and billed.
Maintain a 3 calendar day maximum lag in order to ensure prompt billing and increased cash flow.
11.End of Day (EOD)
Perform end of day duties to ensure the accuracy of all appointment/visit statuses in system.
Review DAR and identify appointments that are not in completed status
Contact clinicians to confirm appropriate status of each appointment.
Update status accordingly (i.e. noshow left without being seen canceled etc.).
12.Other Duties
Perform other duties as assigned based on departmental needs.
Punctuality attendance and flexibility essential in order to meet departmental needs and ensure appropriate clinic flow.
Excellent interpersonal skills and ability to work effectively with physicians coworkers other departments and patients of all ages and from across a broad range of cultural and social economic backgrounds.
Knowledge of medical terminology preferred.
Ability to work as an integral team member under minimal supervision in a fastpaced complex and highly stressful environment
Ability to coordinate prioritize and organize work and patient flow.
Ability to show tolerance and sensitivity in stressful situations and safeguard confidential information in accordance with established policies and HIPAA laws.
Computer literate and ability to use multiple systems and acquire proficiency in the following electronic systems: UChart Cadence/Prelude/Enterprise Billing Passport HealthWorks Compliance Checker Availity RISPACS CaneCare UMCare Intellidose MCSL Experian and all online verification systems used by contracted payors.
Education Requirements (Essential Requirements):
High School Diploma required.
Bachelors degree preferred.
Work Experience Requirements (Essential Requirements):
One (1) year experience in a healthcare or customer service related setting preferred. Consideration may be given to an appropriate combination of education/training and proven experience.
The University of Miami offers competitive salaries and a comprehensive benefits package including medical dental tuition remission and more.
UHealthUniversity of Miami Health System South Floridas only universitybased health system provides leadingedge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center we are proud to serve South Florida Latin America and the Caribbean. Our physicians represent more than 100 specialties and subspecialties and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching research and patient care. Were the challenge youve been looking for.
The University of Miami is an Equal Opportunity Employer Females/Minorities/Protected Veterans/Individuals with Disabilities are encouraged to apply. Applicants and employees are protected from discrimination based on certain categories protected by Federal law. Click here for additional information.
Job Status:
Full timeEmployee Type:
StaffPay Grade:
H3Required Experience:
Unclear Seniority
Employment Type
Full-Time
