Non-Clinical - Administrative - Financial Administrative Representative

TITLE: ER Financial Representative 5:00 PM- 1:30 AM POSITION SUMMARY The Emergency Financial Representative is responsible for ensuring reimbursement to PIH Health from patients or other responsible parties along with assisting patients in understanding their health care insurance coverage by determining eligibility benefits and utilization requirements. The Emergency Financial Representative is responsible for up-front POS collections along with financially securing patients accounts by setting up appropriate financial arrangements with patients to avoid bad debt. The Emergency Financial Representative when appropriate assists patients in accessing programs such as Medi-Cal Uncompensated Care and Hospital Presumptive Eligibility. Emergency Financial Representative will focus on individual performance in registration and financial counseling Key Performance Indicators and expediting approvals by gathering and completing forms before the patient is discharged from the Emergency department. Emergency Financial Representative will continue to enhance their registration and the fundamental financial knowledge and skill set required and expected of this role which is inclusive of the diverse financial programs offered at PIH Health. The Emergency Financial Representative s interaction with patients will only transpire after a medical screening exam has been performed. All patients are seen regardless of their insurance coverage or their ability to pay. The Emergency Financial Representative will complete the comprehensive training program and certification as required to facilitate eligibility for Hospital Presumptive Eligibility qualifications when necessary. SPECIFIC SKILLS NEEDED Demonstrates a clear understanding of PIH Health mission and values Ability to work directly with the insurance company healthcare provider and patients Ability to generate revenue with POS collections establishing payment arrangements along with collecting on all Self-Pay and/or high liability accounts at the point of registration. EMTALA knowledge and experience Demonstrates attention to detail and follow up process Demonstrates ability to communicate effectively and tactfully with patients healthcare providers and insurance companies Excellent English reading comprehension and written skills to include spelling skills and penmanship Excellent Mathematical skills; ability to calculate copay or percentage of financial estimate amount due and/or establish payment arrangements accurately. Ability to follow directions as outlined in policies or given by supervisor Strong computer skills to include typing 45 wpm minimum and in MS office programs Excellent organizational skills Ability to exercise independent judgment at times of need and emergency situations Bilingual preferred Interacts with all levels of hospital and outside vendor staff and knowledge of government regulations Ability to multi-task in a fast and high pressure environment Stringent adherence to all privacy policies and procedures and as required by state and federal law including and not limited to the HIPPA Security and Privacy Rules Strong analytical skills problem solving. The ability to act and decide accordingly. EDUCATION/EXPERIENCE/TRAINING Required Minimum of two (2) year experience in front office/medical billing and/or current hospital registration/admitting Minimum of two (2) year experience in insurance verification and/or medical/hospital billing. High school graduate required or equivalent Knowledge of eligibility requirements for Medi-Cal Hospital Presumptive Eligibility Program Medicare Covered California Cobra limited benefit plans VVC and Uncompensated Care Programs. IPA knowledge Medical terminology Non-Violent Crisis Intervention (NCI) Certification within three (3) months of hire date LA City Fire Card within 2 week of employment (PIHGS Only) Preferred: Evidence of continuing education in Finance Accounting or Business Administration DUTIES AND RESPONSIBILITIES 1. Safeguards and preserves the confidentiality of patient s protected health information in accordance with State and Federal (HIPAA) regulatory requirements hospital and departmental policies. 2. Ensures a safe patient environment and adherence to safety practices per policy. 3. With consideration to age employee utilizes the approved process to resolve biophysical psychological educational and environmental needs of patient/significant other as required. 4. Guest Relations: Exhibits positive guest relations skills by extending oneself and being hospitable to patients physicians coworkers and visitors at all times. Warmly greets these by name and introduces self by name. Uses the phrase How can I help you as a first line of communication. Anticipates concerns and provides an explanation of the interview process. Utilizes translators if available or new translating system Stratus as necessary to ensure patient fully understands the information being discussed with them. Displays a teamwork approach considering the impact of his/her decisions actions and behaviors on others. Works with our eligibility vendor to create a positive working relationship that will provide a smooth process for the patient. Responds to others in a constructive non-defensive manner. Maintains a professional appearance at all times wearing uniforms or adhering to department dress code requirement as per policy. Answers telephone by the third ring and states department this is and how can I help you Expresses ideas clearly actively listens and always follows appropriate channels of communication. Maintains confidentiality at all times. Full disclosure is provided to patient when starting the interview and screening process for Hospital Presumptive Eligibility and/or Uncompensated application so they understand the process. 5. Organizational skills and Efficiency: Sets priorities integrates changes and organizes work activities in a logical and timely manner. When necessary initiate and complete the application process for HPE or Uncompensated benefits by assisting patients with the completion of all the necessary paperwork. Demonstrates a consistent level of performance and productivity by ensuring all insurance demographics and eligibility information is obtained and entered into the registration and financial system accurately and notifies appropriate hospital and eligibility staff of changes. Always strives to make good use of time seeks out work that needs to be done (ex. works follow up accounts where payment was not secured from previous day runs assigned reports on a daily bases to ensure financial documentation is entered in a timely manner etc.) reports free time to supervisors to provide assistance with other department requirements if needed. Responsible for completing all assigned procedures during shift without sacrificing the quality of work. Responsible for communicating and documenting the financial conversation with patient to support what was financially secured or discussed along with any financial arrangement made that will affect the account. Contributes valuable insight on improving workflow for department and decreasing patient wait times. Limits personal phone calls to breaks and lunches. EMERGENCY: Productivity: completes a minimum of 20 registrations but strives for up to 30 registrations per 8 hr. shift which includes scanning documents insurance verification and securing upfront collections. Verifies patients are appropriately medically screened and stabilized before Consent of Admissions is signed/discussed and or liability is requested. No patients are to leave the Emergency Department without registration being completed. When necessary Registration Representative will start the interview and screening process for Hospital Presumptive Eligibility for patients without insurance who present in the Emergency department. Registration Representative will evaluate patients within established guidelines to assist in identifying qualification to the HPE program. Registration Representative will be required to following the M/Cal guidelines and regulatory requirements to secure the most accurate information needed to complete the application process. Registration representative will ensure all insurance demographic and eligibility information is obtained and entered into the system accurately and appropriate eligibility worker is notified. If patient does not qualify for HPE the clerk will pre-screen for hospital s Uncompensated Care program based on financial income and family size. If patient qualifies for this program registrar will complete application process with patient scan accordingly and submit original to the business office for approval process. Registration clerk will document into MS4 the entire process to notify the business office staff of outcome and status for this patient. Timeliness: registers all patients who present in a timely manner. Patients are to have the full registration completed with the COA signature obtained within 30minutes once medically screened by provider. Patient liability is calculated through payment estimator system. If co-pay or percentage amount owned cannot be paid in full then establish monthly payment arrangements to secure account using Payment Navigator in accordance with PIH Health policies for all emergency/ urgent patients seen in the Emergency department. Verification documentation is entered into our financial system in a timely manner and when information is obtained providing a clear chronological record for collector and Business Services. Scan all necessary paperwork on the day received and note in financial system any changes/updates made to account. Priority is to educate patients about their insurance coverage financial liability or any other related financial questions and collect unpaid liability upon patient s arrival or once medically screened in the Emergency department. Responsible for follow up process on discharged accounts when liability was not secured during emergency visit within 1 to 2 days of being discharged. Correction updates and verification is completed in a timely manner. Serves as a resource for assistance or follow up from the Emergency Department Case Management staff Supervisor Registration Manager Systems Patient Access Director Business Services and other departments in a timely manner. 6. Flexibility: Demonstrates ability and willingness to work productively and efficiently in the Emergency Department at management s discretion that will help support the needs of the department. Exercises independent judgment in times of need and emergency situations while adhering to departmental and hospital policies. Demonstrates willingness to adjust work schedule to meet departmental staffing and census needs with a positive attitude and understanding the 24/7 environment in which you work in. Provides financial insurance and registration assistance and information to patients physicians case managers department members and others as needed. Serves as a role model with new implementations for staff and always supports the vision of management with a positive attitude. Adapts current workflow to be a resource during high census or unexpected circumstances where registration or financial services are impacted. Serves as a resource and trainer to new hires/transfers regarding registration insurance issues or education updates. Financial representatives will focus on individual performance key performance indicators and expediting approvals by gathering and completing forms before the patient is discharged. Welcomes the opportunity to take on new responsibilities and challenges; ability to adapt to change with a positive outlook. 7. Complies with all Policies and Procedures demonstrate accuracy through attention to detail. (Minimum standard: 95% of all registrations must be 100% correct) To include but not exclusively: Accurately and completely enters patient demographic employer relative medical and insurance information into the computer as per policies. Downtime registrations are equally complete and accurate upon system being available. Each time a registration is created the FIND PATIENT page in Access Manager is searched and the correct medical record number is selected or entered. Does not create duplicate MPIs. Utilizes all available tools to accomplish accurate registrations to include policies but not limited to: policies cheat sheets emails procedures outlined shared drive Reg Tips and internet. Consistently follows up on incomplete information to ensure complete and accurate registrations prior to billing. COA Driver License or ID Insurance Authorization and other necessary paperwork are to be scanned accordingly. Utilizes all available tools to accomplish accurate verifications to include policies over the phone internet payer information and online eligibility resources. Calls insurance companies visits payor websites or uses online resource to verify and obtain current and accurate benefits that will not place the hospitals revenue at risk. Financial representative will call for complete benefit information. Accurately keys verification and all patient activity related to reimbursement into our financial system; along with scanning online eligibility on applicable plans. During registration process the ER Financial Representative will review each visit for missing content required scanned documents and signatures such as consents COA HIPAA and/or other required financial forms. Immediate follow-up with patient while in the Emergency department or at home after discharge if needed to financially secure account. 8. Collections: Utilizes positive collection skills as per policy while complying with EMTALA laws. Emergency/Maternity/Urgent patients understand that services are provided regardless of ability to pay. Financial Representatives are expected to request payment from all patients that have copay or liability. Representative is expected to meet exceed and maintain monthly department collection goal every month set by Systems Patient Access Director and VP of Revenue Cycle. Educate patients about their insurance coverage along with their financial responsibility in a clear and compassionate manner keeping in mind the mission and values of PIH Health Patients First vision. Financial representatives will work on securing collections on all applicable emergency accounts by establishing payment arrangements with patients if and when full payment is unavailable; next day follow up with patients when payment was not secured during emergency visit. Emergency Financial Representative will demonstrate successful collection skills by collecting payment/setting up payments for 75% of insured patients with liability and some form of payment for 33% of self pay patients that do not qualify for Medi-Cal HPE Covered California or Uncompensated Care. Representative will utilize the Payment Estimator System when applicable to calculate patient s financial estimate due for the Emergency visit. Enters payment in the Payment Navigator system. Representative will demonstrate knowledge of PIH Health Cash Rate/Self pay discount programs and pricing for the Emergency department. Emergency Financial Representative is responsible for accurately securing and placing all financial collections into secured safe as instructed by department supervisor. All money from petty cash and in the department safe must be accounted and secured daily as instructed by department supervisor and verified with department Lead or another co-worker. Representative will notify department Registration Supervisor immediately when the Payment Navigator check reader needs maintenance or any discrepancy in cash totals. 9. Growth: Demonstrates participation in the Performance Improvement program. Turns problems into opportunities for improvement. Demonstrates an active interest in improving current level of skill and knowledge by regularly reviewing Policy and Procedure on the internet home page including Disaster and Safety material. Attends and participates in each staff meeting as well as other hospital/job specific required education. Completes comprehensive training programs as required and set by management annually. Ability to follow directions as outlined in polices or given by supervisor. Maintains job knowledge by participating in educational opportunities and training sessions. Enhances department and hospital reputation by accepting ownership for accomplishing new and different request; exploring opportunities to add value to job accomplishments. Demonstrates willingness and ability to learn new skills and to adapt to change. 10. Attendance: Adheres to attendance policy and provides notification of absence as per policy. Takes responsibility for keeping and knowing work schedule and any schedule changes. Notifies supervisor far in advance of requests for schedule changes and what options are applicable if any with these new request changes. PTO requests are submitted per outlined department procedure with the understanding these requests may not be guaranteed due to the 24/7 department requirements. Time Correction forms are properly completed and turned in by your next scheduled shift or sooner if error occurred with time clock or badge issues. Department supervisor is immediately notified of this error. Keeps to a minimum request to leave work earlier than scheduled shift time ends so department coverage is never compromised. 11. Safety: Maintains a clean and safe work environment as per policy. Reports all problems immediately. Completes all required CBT s and annual health evaluations before annual review due date assigned by department supervisor. 12. Performs other duties as assigned by department supervisor with professionalism. TEAMWORK/CUSTOMER SERVICE RESPONSIBILITIES: 1. Customer Service Values and Behaviors: 1.1 Value: Each person is treated with respect dignity fairness and compassion. Behavior: Performance is acceptable when everyone is promptly greeted with a smile in a warm and caring manner using the person s name whenever possible. Now matter how I feel I display a caring attitude. 1.2 Value: Each person displays loyalty and pride in PIH Health and upholds the confidentiality of patients visitors physicians and co-workers. Behavior: Performance is acceptable when concerns/problems with fellow employees and customers are not discussed with anyone other than the person involved or the supervisor. Customer issues and ideas are listened to and appropriate follow up occurs to create a satisfied customer. I do not make excuses. I do not demean other people or departments. 1.3 Value: Each person demonstrates commitment to open communication. Behavior: Performance is acceptable when openness and acceptance of constructive criticism occurs. Positive communication occurs by complimenting and expressing appreciation to others. I will listen and encourage others to express ideas and opinions. 1.4 Value: Each person demonstrates pride in the physical appearance of all PIH Health properties. Behavior: Performance is acceptable when the initiative is taken to maintain a clean and safe environment. I conduct myself in a manner which respects and preserves equipment and the physical plant. I do not walk by spills trash or unsafe conditions without assuring that they are attended to promptly by me or appropriate personnel. PERSONAL QUALITES: Punctual Effective communication skills organized dependable with a positive professional appearance and attitude Must be able to handle multiple tasks at the same time. Creative Exceptional customer service and negotiation skills Organizational skills analytical skills time management ability to work under pressure decision making and problem solving skills High degree of accuracy and attention to detail With consideration to age employee utilizes the approved process to resolve biophysical psychological educational and environmental needs to patient/significant others when administering care. Ability to plan organize and exercise sound judgment Ability to collect analyze and research complex or diverse information