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Patient Access Representative II

Crystal Clinic Orthopedic Center

This is a Contract position in Cuyahoga Falls, OH posted September 15, 2020.

Job DescriptionJob Title: Patient Access Representative IIDepartment: Nursing Department/Patient AccessReports To: Department SupervisorPrepared Date: 07/27/15; 4/11/17POSITION SUMMARY:The Patient Access Representative II supports the clinical operations of The Crystal Clinic Orthopaedic Center by performing the registration or clerical functions to ensure patients have prompt access to CCOC services. This position serves as a role model/lead providing advanced patient access knowledge and skills, problem solving, and coordination of access services. Performs all call center scheduling, arrival desk, and / or departure activities throughout multiple locations for the Crystal Clinic.ESSENTIAL FUNCTIONS, DUTIES AND RESPONSIBILITIESIncludes the following but are not limited to:* Handles a wide variety of patient inquiries (on the phone or in person) regarding appointments and services to ensure that patients can access CCOC services with minimal hassle or delay.* Answers the telephone in a pleasant and courteous manner within three rings, identifying self and organization.* Accurately, efficiently and professionally registers patients to insure integrity of patient data in HMS and Centricity systems.* Verifies insurance eligibility for upcoming patient appointments using, AHIQA system.* Notifies patients to explain deductibles and out of pocket expenses as necessary.* Communicates with physician’s office when prior authorization / pre-certification are required and not yet on file in systems. Escalates to Patient Access Director and provides detailed timeline of events as needed.* Collects referring physician demographic information for communication and follow-up.* Conducts patient/guarantor interviews, explains hospital policies, financial responsibilities and patient Rights and Responsibilities and Notice of Privacy Practices.* Identifies co-payments / out-of-pocket expenses, advises patients regarding the need for payments at / or prior to the time of service.* Identifies patients in need of financial counseling to collect payments by following CCOC policies and guidelines* Accurately schedules appointments (office visits, tests, or procedure) by following specialty and physician specific guidelines and/or routes the patients to the appropriate area for further follow-up/ scheduling.* Processes internet appointment requests and responds to patient according to departmental policy.* Performs visit preparation, appointment reminders, records and tracks no-show patients, and other point of service activities as assigned.* Consistently follows check-in procedures for all patients ensuring that all forms are collected, completed, signed, and scanned into systems.* Facilitates the cash collection, as needed, for services rendered and ensures payments received are balanced and batched correctly according to CCOC policy.* Communicates to nursing, physicians, technicians, secretaries, and supervisors regarding issues relating to patient wait times, late arrivals, or other delays.* Ensures same day add-on appointments are communicated to appropriate department personnel and authorization is obtained.* Recruits, registers, and trains patients on how to use Patient Portal systems.* Schedules all follow-up appointments or procedures using HMS and Centricity systems and provides proper patient instructions.* Maintains up-to-date knowledge of computer systems, insurance / government regulations and Patient Access policies/ procedures used within CCOC.* Handles sensitive information including, but not limited to, patient records, charts, hospital documents and employee information is kept confidential without exception, according to HIPAA guidelines.* Provides input to leadership to identify workflow issues and resolutions.* Assists others in achieving greater work efficiencies through coaching, answering questions, and referring to appropriate resources.* Provides advanced Insurance Verification beyond AHIQA when a response is not provided through automated systems, or requires further investigation. This is accomplished through accessing insurance websites, or occasional phone contact.* Assists in new employee orientation and training of new staff and recognizes training needs for current staff.* Maintains knowledge of and changes to registration / billing requirements and communicate to department staff.* Maintains sub-specialty and physician specific scheduling guidelines to promote scheduling accuracy.* Maintains temporary and permanent physician / provider schedule changes in Centricity.* Attends monthly Patient Access meetings and communicates information to teams in written meeting minutes and verbal communication in team meetings.* Covers and is proficient in 2 or more areas related to patient access.OTHER FUNCTIONS* Provides back-up coverage and assists in daily office routine when needed in other areas* Keeps Departmental Leadership informed of key issues* Performs other duties as assignedWORK STANDARDS* Works well with patients, physician(s) and other CCOC employees* Successfully meets Unit Specific Skill Sets* Complies with all Standards of Behavior set forth by CCOC* Adheres to policies and procedures set forth in CCOC Employee Manual* Adheres to the CCOC attendance policy* Follows HIPAA, OSHA and Compliance Plan regulationsNOTE: The above stated duties are intended to outline those functions typically performed by individuals assigned to this classification. This description of duties is not intended to be all inclusive or to limit the discretionary authority.QUALIFICATIONSTo perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.EDUCATION and/or EXPERIENCE* High School diploma or GED required.* Minimum of three (3) years in patient registration, scheduling, or related healthcare experience preferred* Demonstrated knowledge of third party payer and worker’s compensation required.* Demonstrated knowledge of insurance preauthorization/ referrals.* Demonstrated problem solving and prioritization skills in order to manage multiple tasks successfully throughout the day.* Prior computer experience (i.e. Microsoft Office suite, printers, copy machine, multi-line phone, FAX machine, etc.) required. Experience using clinical computer systems preferred.* Requires strong customer service and oral communication skills.* Able to work independently with minimal direction.* Basic knowledge of medical terminology required.* Proficient PC Skills including MS Office products, typing skills, and familiar with operation of standard office equipment.* Demonstrated professional demeanor when responding to patients / customers.* Ability to cover in more than two (2) areas related to Patient Access for coverage purposes.NOTE: The above stated duties are intended to outline those functions typically performed by individuals assigned to this classification. This description of duties is not intended to be all inclusive or to limit the discretionary authority of High School diploma or equivalentCOMMUNICATION SKILLSMust be able to effectively communicate with physicians, insurance companies, other CCOC employees and other stakeholders.Must be able to take appropriate action in a stressful situations/environment.SKILLSRequires critical thinking skills, analytical skills and the ability to work with minimal supervision.Requires strong communication, customer service and interpersonal skills.Incumbent must possess excellent computer skills and knowledge of office equipment.Demonstrated problem solving and detailed oriented skills required.Multitasking is necessary. Possess critical thinking skills to process tasks accurately; requires high level thinking to understand and problem solve. Must be able to take appropriate action in a stressful environmentPHYSICAL REQUIREMENTSMust be able to sit and/or stand for prolonged periods. Must have the dexterity to operate a computer keyboard and basic office equipment. Requires constant sitting and data entry. Must be able to lift up to 25 pounds. Typical physical demands include a high degree of dexterity to produce material on a PC; normal or corrected vision and hearing. Requires constant sitting and data entry. Travel between locations may be required.As an organization, all employees with patient contact are expected to demonstrate competencies, specific to their job duties, for the following patient population categories:Elderly, Children, Cardiac, Neuro, Surgical, Impaired (Hearing/Visual), Cultural, Age.NOTE: The above stated duties are intended to outline those functions typically performed by individuals assigned to this classification. This description of duties is not intended to be all inclusive or to limit the discretionary authority of supervisors to assign other tasks of similar nature or level of responsibility.