Position Type: Full-time / DAYS/ 12 HR Shifts
Reports to: Patient Access Representative Supervisor
Department: Patient Financial Services
Summary/Objective: Patient Access Representative (PAR) is the first line of exceptional customer service patients and providers experience at Sweeny Community Hospital (SCH). The PAR will be tasked with registration, scheduling, insurance verification, authorizations, patient responsibility estimates, order reconciliation, scanning, and directing patients as needed.
Registration, Scheduling and Pre-authorization
1. Answers calls in a prompt, professional and courteous manner; addressing the caller’s needs, unless beyond their scope of knowledge; transfers calls or takes messages when appropriate.
2. Checks messages and hospital email timely, at least morning/noon/end-of-day and takes immediate action.
3. Greets those presenting to Registration, ascertains needs and take appropriate action.
4. Overhead paging, code/trauma paging, drills and monitors EMS radio ER traffic (OP or ED specific)
5. Places calls when required to assist healthcare team with facility to facility transfers or notifying authorities.
6. Communicates promptly with patient, family members, physician, and clinical department if delays are anticipated/encountered.
Registration, Scheduling, and Pre-Authorization:
1. Accurately and efficiently pre-registers, quick registers or registers patients for services
2. Follows established procedures to obtain and confirm patient demographic, ID, and insurance information for every visit.
3. Follows established procedure to obtain and confirm insurance eligibility & benefits at every visit.
4. Obtains patient or designee signature on all required consents/forms.
5. Follows established procedure for scanning & data housing of insurance, identification cards and consents.
6. Follows established procedures to obtain required authorizations prior to procedures or inpatient/observation stays. Communicates scheduled events & appropriate pre-test information to patient/family member, as necessary. Provides reminder call ahead of scheduled outpatient testing.
7. Completes Medical Necessity reviews as required and notifies ordering physician if codes fail Medical Necessity. Issues and explains Advanced Beneficiary Notifications to patient/family member as required, ensuring CMS compliance
8. Maintains accurate physician/provider orders in compliance with established guidelines by HIM. Takes appropriate action if orders are expired or incomplete.
9. Follows established protocol for post-registration action related to patient’s care.
10. Completes Admission Packets and Medicare IM for Medicare Inpatients and MOON forms those OBS Patients
11. Maintains current knowledge base for insurance changes, updates, and processes as they apply to patient access.
1. Notifies patient of estimated patient responsibility for services at time of scheduling. Collects deductibles, co-pays, co-insurances, or self-patient responsibility at that time. Discusses and executes financial options with patients prior to scheduling outpatient elective procedures.
2. Collects patient responsibility after initial evaluation in ER or at time of services
3. Refers patients to the Care Program Coordinator when appropriate
4. Receives, processes, and post patient payments and non-patient purchases and provides receipts
5. Follows established procedure to balance cash drawer at beginning and end of shift.
6. Places change request to maintain par-levels of bills and coins to meet daily treasury needs in the hospital. Reports variances immediately to supervisor and aids in resolution.
Required Education, Experience and License:
Preferred Education, Experience and License:
Additional Eligibility Qualifications: