Him/Patient Access Representative (Full Time)

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.

– 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 payment for services.

Maintain accurate records of cash, check, and credit card payments. Understands and follows all regulatory requirements including but not limited to: Emergency Medical Treatment and Labor Act (EMTALA), Health Insurance Portability and Accountability (HIPAA), and Red Flag Rules. Performs alternate provider workflow for non-staff providers including: NPI check and OIG Exclusion List checks.

Documents all information in EHR. Informs patients of and obtains signatures timely for all registration forms including but not limited to: Conditions of Admission, Patient Rights and Responsibilities, Notice of Privacy Practices, Acknowledgment of Patient Information on Advance Directives, Notice of Patient Visitation Policy, Patient Registration Form, Important Message from Medicare, and Medicare Observation Notice.

Possesses knowledge of and can explain all forms, required registration information, and procedures as needed. Creates armbands, labels, and other documentation as necessary. Places armbands on patients following appropriate policy and procedure.

Completes Medicare Secondary Payor Questionnaire and documents responses in EHR. Explains to Medicare patients options printed on the Advance Beneficiary Notice (ABN) and assists the patient completing the form. Scans and documents the ABN into the EHR.

Assists patients with filling out medical records release forms. Verifies patient identity and documents on forms. Sends all Release of Information (ROI) forms to Health Information Management (HIM).

Promptly answers phone calls at workstation and directs to appropriate area as necessary. Acts as District Operator coverage outside of business hours or as needed. Answer all incoming calls, provide pertinent information to the caller, or screen and transfer the call to the appropriate source if requested Relay voicemails and other messages to the proper location within the organization, which may entail writing down the number of the person who called and providing it to the individual Perform various word processing responsibilities, which can include proofreading documents before they are sent out or updating the company’s phone directory.

Record voicemail message for the company phone system, including messages stating when the office will be closed for holidays. Displays exceptional customer service with patients, visitors, and peers by addressing and treating all with respect and understanding. Attends and engages in department meetings, projects, teams, trainings, and committees.

Utilizes interpreter service to communicate with patients when needed. Completes all job functions with discretion ensuring patient privacy and confidentiality. Responds to emergency calls and pages emergency announcements in accordance with emergency response policies.

Performs hospital front desk duties. Receives visitors, obtains names and nature of business, and provides information and direction. Works shift and area as assigned on schedule.

Is cross trained in different coverage areas of Patient Access and HIM when requested. Enters safety, feedback, and disruptive event reports as needed. Always utilizes critical thinking.

Actively looks for solutions and shares ideas for improvement with team. Maintains proactive and positive communication with management team, peers, and patients at all times. Exhibits professionalism in appearance, speech and conducts following department dress policy while on shift.

Works on special projects as assigned. Demonstrates the District’s Values in performance and behavior. Complies with the District’s policies and procedures.

Check for duplicate medical records numbers. Assists with referrals and pre-authorization tasks. Other duties may be assigned.

Performs chart reconciliation and prepares the documents for scanning. Follow-up on any missing documents and reporting of missing documents to the department head and HIM Director. Accurately scan and title medical records received from other facilities, as well as our own, to the designated patient’s encounter and document name in the Electronic Health Record (EHR).

Maintains an accurate and efficient filing of the old paper charts and stores the scanned documents in the Chart Room in an orderly manner. Have an excellent understanding of medical record processes. Maintain the medical record storage area.

Is the key contact of the HIM department. Has excellent telephone and customer service attributes. Demonstrates knowledge and understanding of the rules of confidentiality, chart analysis, terminal digit filing, scanning into the Electronic Health Record (EHR), and all policies and procedures associated with the job duties in a Health Information Management Department.

Schedules patients for outpatient and walk-in services. Assists in scheduling patients at check out. Documents all estimates, conversations, and collections in EMR.

Utilizes patient schedules to prepare for patient appointments when possible, including but not limited to missing registration items, patient estimates, forms, schedules, and notes.

– Level 2 Proficiency in Level 1 functions plus: Obtains prior authorization for outpatient services. Checks to ensure authorization has been obtained prior to services being rendered. If authorization is not in place, reschedule the service.

Creates an estimate and discusses intent to proceed with a Non-Authorized Service as needed. Scans all appropriate documentation into the EHR. Insurance Verification- accurately deciphers eligibility reports and confirms coverage and for medical services provided.

Holds sufficient understanding of insurance protocols for orders, authorizations, referrals, co-payments, deductibles, allowed amounts, etc. Maintains and updates knowledge regarding all types of insurance and health plan coverage, utilizing reference materials provided, when necessary. Performs quality checks, reports, audits, note-taking, and other clerical tasks for department when requested.

Works EHR work queues, pools, and worklists during each shift. Follows up on all items including pre-registration and pre-admission missing registration items, emergency room visit missing registration items, appointment missing registration items, admission missing registration items, discharged patient missing registration items, returned mail, and claim edits. Acts as mentor and operational trainer to new team members in conjunction with the Registration Lead.

Trains, validates, and competency checks new team members. Communicates progress of trainee to Lead and supervisor. Release medical records per facility policies, California Privacy Laws, and HIPAA regulations.

Performs 5% audit of scanned documents and reports mis-scans or missing images to the department director prior to destruction of the hard copy of scanned charts. Purge medical records per retention directives. Perform routine maintenance on the switchboard system or contacts outside contractor to visit the office to fix the system when necessary.

Obtains worker’s compensation accident information when applicable. Calls patient employer to verify employment. Obtains all insurance information from employer timely.

Contacts insurance company to gather claim information. Enter all information into EHR.

– Level 3 Proficiency and 3 years of experience in Levels 1-2 Utilizes price estimation tool, when applicable, to provide the most accurate estimate to patients. Initiates patient financial conversations with respect and privacy. Creates estimates for services and delivers to patients.

Collects estimated amount due. Assist physicians in record completion and analysis Assist with referrals and obtaining prior authorization when assigned. Follows up on all worklist, queues, and pools and provide status to management daily.

Reaches out to lead or director for guidance and education for items unable to process.

– Level 4 Proficiency and 4 years of experience in Levels 1-3 Performs Chart Analysis for all patient types Physician Suspension Works closely with coding to process the DNFB with coding to determine missing documentation and reaches out to the provider to complete visits. Compiles and processes Peer Review Submits charts to Cancer Registry and is contact Assists with Policies and Procedures management and training Assists with HCAI State Submissions Investigates complex insurance denials and edits; then brings resolution to management.

At the discretion of the Department Manager, years of experience may be waived to be moved to the next level. Physical Requirements, Safety, and Environmental Conditions Follows safe work practices, takes an active interest in preventing injury or illness and promoting a safe and healthful environment for self and others, and complies with Hospital and governmental safety regulations. Must function independently, have personal integrity, have flexibility and the ability to work effectively with other personnel, clients, and support agencies Sits, stands, bends, lifts, walks, and moves intermittently during working hours and ability to lift up to 20 lbs.

Compliance Assumes personal responsibility to comply with all Federal, State and local laws governing business conduct, conducts business in an ethical and trustworthy manner, and displays the qualities and characteristics of a professional at all times when dealing with patients, visitors, physicians, volunteers, and fellow employees. Exemplifies the Seneca Core Values in all aspects of work responsibilities and demonstrates these values to fellow employees and