The Patient Access Advocate I provides primary registration of patient accounts for self-pay, government and commercial accounts on date of service for scheduled and unscheduled visits. Perform registration functions, including updating of demographics, insurance verification, collection of point of service liabilities and documentation of registration information within the ADT system. Confirm account being registered has accurate information to ensure clean billing.
Must possess basic knowledge of Medicare (CMS) guidelines, as well as other Compliance Regulatory guidelines applicable to Patient Access. Provide the highest level of customer service to patients/family at time of service through registration interactions as well as providing wayfinding to patients and/or visitors. Type of Opportunity: Full time Job Exempt: No Job is based: PRESNow 24/7 Urgent and Emergency Care - Isleta Work
12 Hour Nights
Customer Service and Caring Practices: *Ability to provide exceptional patient experience for patients and patient families by using CARES, AIDET and EPE tools. *Addresses and attempts to appropriately resolve complaints in the moment by using key words at key times and de-escalation processes. *Ability to manage conflict and appropriately request the help of a supervisor when needed. *Implement PROMISE and CARES behaviors in every encounter. *Educates patients for whom they speak regarding insurance benefits and liabilities. *Ensures accounts are financially cleared at time of service through account review. to alleviate patient concerns over hospital financial matters Encounter Components: *Performs the patient registration process.
Manage the accurate collection of patient data which includes but is not limited to; *Obtain/confirm and enter demographic and other financial information, not obtained during pre-registration/financial clearance process, necessary for account completion. *Obtain missing insurance information, to include policy number, group number, date of birth, and insurance phone number if not already identified in account. *Verify insurance for eligibility and benefits using online electronic verification system or by contacting payer directly. *Accurately document actions taken in the system of record to drive effective follow-up and ensure an accurate audit trail. *Maintain ongoing knowledge of authorization requirements and payer guidelines.
Maintain a knowledge of Medicare (CMS) guidelines as it relates to admissions and outpatient services. Ensuring compliance with admissions forms, benefit entitlement verification, and billing requirements. *Ensure accurate completion of MSPQ at time of service if not completed during financial clearance process. *Daily focus on attaining productivity standards. *Monitor and track Data Quality program to ensure errors are corrected at time of service. . *Maintain appropriate records, files, and timely and accurate documentation in the system of record.
Other duties as assigned Financial Accountabilities: *Collects identified patient financial obligation amounts including residual balance if applicable. Collect liability from patient at time of service. *Educate patients on financial assistance, charity or other programs that may be available. *Refers as appropriate to on site Financial Advocate or to the Financial Advocacy Center Patient Relations: *Complete any information missing from the account to ensure accuracy at time of visit. *Transparency with patients through communication of patient liabilities..
Quality Improvement: *Perform assigned patient care responsibilities, which may include but not limited to: *Cooperate fully in all risk management activities and investigations. *Report promptly any suspected or potential violations to laws, regulations, procedures, policies, and practices, and cooperate in related investigation. *Conduct all transactions in compliance with all company policies, procedures, standards, and practices. *Demonstrate knowledge of all applicable compliance and legal requirements of the job based on the scope of practice of the position.
C. A. R.
E. S Behaviors: *Demonstrates CARES behaviors of Collaborate, be Accountable, Respect, Engage and Serve to all whom you encounter.
*High school diploma/GED *6 months experience in healthcare setting or 1 year customer service background. *Pass 2 week Patient Access Academy with a passing score of 85% or higher (within 6 mos of start). *CHAA, CHAM or other industry equivalent certification preferred *Basic understanding of insurance preferred. *Basic understanding of medical terminology and billing codes (DRG, ICD-10, CPT, HCPCS) preferred *Requires basic understanding of registration and healthcare. *Demonstrated strong keyboarding skills, ensuring efficient data entry and documentation. *Knowledge in Microsoft Office Products. *Pass EPIC proficiency test required with a 85% score at completion of the Epic Training class.
Candidates must be at least 18 years of age at the time of hire All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits. Wellness Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being.
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Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses. Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans. AA/EOE/VET/DISABLED.
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