LOCATION : KONA COMMUNITY HOSPITAL | Admitting - Ambulatory Services POSITION STATUS: 1.00 | Permanent SALARY RANGE: BU03 | SR17 SALARY RATE: $54,756 (Annual Salary) based on the Full Time Employment SHORTAGE DIFFERENTIAL : $692/month JOB DUTIES: I. MAJOR DUTIES & RESPONSIBILITIES A. PATIENT ACCESS DUTIES This position acts as the Lead Patient Access Representative: 1.
Ensures outpatient admissions are completed, insurance verified, and pre-authorizations obtained; regulated consents are signed before scheduled treatment. 2. Communicates daily with patients and insurance companies to validate information, including demographic, insurance, secondary insurance, financial, and other pertinent data. 3. Generates orders, referrals, and sends to appropriate outside providers per Doctor's orders. 4.
Obtains insurance verifications of benefits and eligibility. 5. Ensures patients are aware of third-party payer requirements 6. Discuss and determine the method of payment with the patient and/or responsible party, collect deposits, and acquire signatures on all pertinent forms 7.
Coordinate accurate data to determine financial obligation based on policies, including the collection of insurance co-payments, self-pay deposits, and patient balances. 8. Ensures that all next-day scheduled appointments are pre-registered, information verified, and preauthorization/precertification acquired, and all self-pay accounts are passed onto Patient Account Representative V within 24 hours of scheduling. 9.
Audits accounts to maintain a 100% accuracy rate for demographic and insurance information. 10. Communicates with hospital personnel, medical staff, patients, family members, and outside agencies to ensure quality patient care. 11. Assists in training new employees; reviews the work of lower-level Patient Services/Access Representatives for completeness, accuracy, and adherence to applicable policies and procedures. 12.
Research and update previous records within the information system or enter information to create a new file. 13. Prepares a patient's wristband and attaches the wristband to the patient. 14. Inputs additional information into the system as directed. 15.
Complies with rules, regulations, rights, and statutes of the State, Federal, and hospital regulatory agencies. 16. Pre-screens appointment schedules and works 1-2 weeks out with provider schedules, along with checking daily add-ons. 17. Works with the Supervisor to obtain any/all retro-authorizations promptly. 18.
Appeals denials and/or sets up peer-to-peer reviews. 19. Responsible for ensuring edits on specialized Patient Access worklists and validation reports are resolved. 20. Communicates to the Supervisor any edits that cannot be resolved and works on solutions. 21.
Works with the Supervisor to resolve complex insurance claims, third-party billing, and collection on all outstanding accounts. 22. Works with the Supervisor to review, improve, develop, implement, and monitor departmental workflows and processes. 23. Assists Patient Access staff in resolving any computer or process-related registration issues that may arise. 24.
Communicates any training needs to the Supervisor and conducts training within the scope of their knowledge. 25. Works with the Patient Financial Services staff to resolve/correct any Patient Access/Account-related issues that are preventing claims from being processed. 26. Serves as backup to cover Patient Access Representatives as needed when other coverage cannot be found. 27.
Reports to the Supervisor any staffing needs and works with the Supervisor to ensure these needs are filled. 28. Assists in training new employees; reviews the work of lower-level Patient Access Representatives for completeness, accuracy, and adherence to applicable policies and procedures. 29. Assists in implementing appropriate billing, credit, and collection procedures.
B. PRE-ADMISSION/ADMISSION OF PATIENTS 1. Coordinates activities related to accurately determining patient financial obligation based on facility policies/procedures, including the collection of insurance co-payments, self-pay deposits, and patient balances. 2.
Communicates with hospital personnel, medical staff, patients, family members, and outside agencies to ensure quality patient care. 3. Interviews patients or their representatives and obtains demographic and primary and secondary insurance information. 4. Research and update previous records within the information system OR enter information to create a new file. 5.
Notifies appropriate hospital personnel of new registrations so that admitting orders can be obtained, as it pertains to scheduling outpatient infusions on holidays/weekends. 6. Initiates and accurately completes all necessary admitting forms, recognizing that these documents constitute a medical-legal document. C.
INSURANCE VERIFICATION - POINT OF SERVICE CASH COLLECTIONS 1. Contacts insurance carriers to obtain benefits and eligibility for the specific insurance plans. 2. Utilizes electronic media for validating insurance plan codes, certificate numbers, and expirations of coverage. 3.
Validates the certificate numbers for each insurer/subscriber. 4. Enters the subscriber verification information in the hospital patient database system. 5. Updates patient record with specific changes required before bill production. 6.
Conducts precertification when necessary to ensure coverage for services. 7. Addresses error resolution with the appropriate Patient Access staff for improved future results. 8. Responsible for daily reconciliation of cash collections and reviewing the daily cash journal report for accurate collections.
D. CENTRAL COMMUNICATIONS 1. Answers and refers incoming calls to the proper department or person. 2.
Refers to disaster procedures and promptly notifies key hospital personnel of an anticipated/actual disaster. 3. Participates in County Civil Defense exercises and dry-runs. 4. Refers employee sick calls to the respective department head.
E. OTHER UNIT
- 1. Assists with helping patients find financial support for external services (i.e., medical equipment, clinical trials, and additional medical services not available at Kona Community Hospital Cancer Center that are necessary for their cancer care). 2. Gathers patient clinical and financial information and provides ongoing data to the patient care team. 3. Assists with connecting the patient to community support services for financial assistance for travel and ground transportation (i.e., American Cancer Society). 4. Cover Patient Account Representative V duties as necessary. 5. Receives all returned patient statements, obtains the correct mailing address, and forwards them to the patient. 5. Communicates and interacts with patients, families, and other staff members positively and courteously. 6. Compliance with mandatory in-service requirements (e.g., patient rights, crisis prevention, annual mandatory health and safety, etc.) 7. Maintains the strictest confidentiality of all facility and facility-related employee/ patient information. 8. Participates in activities of the department (i.e., The Joint Commission (TJC), Safety, Performance Improvement, and Infection Control). 9. Adheres to hospital rules and regulations, policies, and procedures. 10. Plans and organizes workload and is aware and flexible to the acute needs of the section. 11. Considers age-specific needs when serving or assisting patients: ___ Infants (0
- 2 years) ___ Adults (19
- 70 years) ___ Pediatrics (3
- 12 years) ___ Older Adults (greater than 70) ___ Adolescents (12
- 18 years) 12. Uses knowledge of different cultures when interacting and assisting patients. Performs other related duties as assigned. THE MINIMUM QUALIFICATION REQUIREMENTS ARE: Applicants must meet all of the following requirements. Please note that unless specifically indicated; the required education and experiences may not be gained concurrently. In addition, qualifying work experiences are based on a 40-hour work week. Other information: EDUCATION REQUIREMENT: High school diploma or equivalent. GENERAL
Two (2) years of typing, stenographic, clerical work, cashiering, data input, customer service skills or any combination of these experiences which duties demonstrated knowledge of English grammar, spelling, arithmetic, standard office equipment; and the ability to read and understand oral and written instructions, carry out procedures in clerical work systems, speak and write simply and directly, observe differences in copy and proofread words and numbers quickly and accurately, and operate various kinds of office equipment; and ability to deal effectively with others in eliciting information and providing service.
SUBSTITUTION OF EDUCATION FOR GENERAL
An Associate’s or Bachelor’s from an accredited college or university may substitute for all of the General Experience required. SPECIALIZED
Three (3) years of work experience performing admission activities in a hospital; interviewing patients and/or responsible persons to secure information, securing signatures for insurance benefits; arranging for method of payment for costs not covered by insurance; and preparing admitting records. QUALITY OF
The number of years of experience required for any grade level represents the minimum amount of time necessary to qualify for the appropriate position, but length of time is not in itself qualifying. The applicant's work experience must also have been of a quality and scope sufficient to enable them to perform satisfactorily assignments typical of the grade level for which they are being considered. KNOWLEDGE AND ABILITIES REQUIRED: KNOWLEDGE OF: Thorough knowledge of admissions policies and procedures; and techniques of interviewing.
Knowledge of federal regulations including COBRA, Advance Directives, Medicare, Medicaid, The Joint Commission, OSHA, and HIPAA as they relate to hospital intake and payment for services. Knowledge of medical billing and collections in a hospital or Long Term care facility, Healthcare Financing Administration (HCFA) Uniformed Billing (UB)-92/Medicaid Drug Claim Form 204, HCFA 1500 Claim forms, third party insurance (i.e., Medicare, HMSA, Medicaid); rules, regulations and requirements of medical billing, International Classification of Diseases, 10th Revision (ICD-10, Current Procedural Terminology (CPT), Healthcare Common Procedural Coding System (HCPCS), Diagnosis Related Group (DRG), and Resource Utilization Groups (RUGS).
Knowledge of charity care, payments, Direct Date Entry (DDE), Hawaii Healthcare Information Network (HNIN), third party on-line claims adjudication websites, third party regulatory requirements, claim denials, appeals management, prior authorization, Notice of Discharge and Medicare Appeal Rights (NODMAR), credit balance, refunds and third party benefits; and principles and practices of supervision. ABILITY TO: Understand and interpret laws, policies, rules and regulations pertaining to the work; develop methods and procedures relating to admission activities; instruct others; and deal tactfully and effectively with the general public; reviews the work of subordinates.
I. WORKING CONDITIONS/PHYSICAL REQUIREMENTS Applicants must meet the health and physical requirements deemed necessary to effectively and safely perform the essential functions of the position with or without reasonable accommodation. ALL CIVIL SERVICE JOB VACANCIES WILL BE POSTED FOR A MINIMUM OF TEN (10) CALENDAR DAYS The Hawaii Health Systems Corporation is an equal opportunity employer and complies with applicable state and federal laws relating to employment practices QUALITY OF
Possession of the required amount of experience will not in itself be accepted as proof of qualification for the position. Overall paid or unpaid experience must have been of such scope