Outpatient Access Rep

New Haven, CT
Dec 3, 2018

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Job Description

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values-integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
EEO/AA/Disability/Veteran
Summary:
Responsible for coordinating various access functions, such as: registration, insurance verification and financial clearance, agency/free care application process and follow-up, and account resolution functions. Ensures positive interactions with patients, family members, medical staff, third party representatives and hospital personnel. Promotes good customer service in the work environment. Effectively utilizes all computer systems to ensure that the responsibilities of the Registration Department are met. Performs certain statistical and QA functions. Develops new procedures and participates in the planning and implementation of system improvements to enhance the operating functions of the department.
Responsibilities:
  • 1. CUSTOMER SERVICE - Creates a patient/family, physician and employee experience that exemplifies caring, understanding, efficiency and overall quality of service. Demonstrates the ability to balance customer service with the financial needs of the hospital.
  • 1.1. Identifies events where the service to a customer was less that optimal and escalates issues appropriately.
  • 1.2. Contributes to a positive work environment by actively discouraging -we versus they- thinking.
  • 1.3. Works with clinical staff to ensure smooth efficient patient flow.
  • 2. COMPUTER KNOWLEDGE - Maintains knowledge of current computer systems, for example those used in registration, scheduling, accounts receivable, patient care, patient tracking and eb based on-line eligibility systems.
  • 2.1. Utilizes Microsoft packages.
  • 2.2. Participates in internal and external committees as related to the enhancement or development of computer systems.
  • 2.3. Monitors, evaluates and responds to system abnormalities.
    Recognizes when to make workflow changes and when to escalate issues appropriately.
  • 3. REGISTRATION FUNCTIONS - Exhibits a thorough understanding of various insurance carrier/verification guidelines and knowledge of third party payor policies. Stays abreast of insurance changes as they affect the verification and processing of accounts. Takes appropriate actions to address problems when identified.
  • 3.1. Verifies eligibility as outlined in departmental procedures.
    Assists in quality assurance audits utilizing various reports and/or worklists.
  • 3.2. Establishes and maintains open communication with all insurance provider representatives and physician offices.
  • 3.3. Ensures proper account documentation of benefits and authorizations, and follow-up by staff during and after the patient's visit.
  • 3.4. Adheres to standards for the collection of cash and the daily cash reconciliation process. Enters financial data into the computer systems and maintains accurate financial records. Retains cash logs and report statistical data as required. Collects cash payments appropriately for patients, makes referrals for financial counseling, determines the necessity of third party sponsorship and processes patients in accordance with the YNHH policies and procedures. Assists in arranging payment.
  • 3.5. Provides input and offers solutions for improvement on operational workflow.
  • 3.6. Assists in quality assurance audits utilizing various reports and/or worklists.
  • 4. CHART PREPARATION - Ensures the timely generation and distribution of documents as required by departmental procedure to ensure timely processing of the patient's medical record.
  • 4.1. Follows departmental procedures in obtaining required medical record documentation.
  • 4.2. Ensures department maintains an accurate system of sorting, dating and filing documents to ensure the integrity of patient information.
  • 4.3. Ensures that an accurate audit trail is maintained of the document retrieval process by following established documentation procedures.
    Other information:

    EDUCATION:

    High School graduate with demonstrated continuing education at a college level program or equivalent experience. Associate or Bachelor's Degree preferred.

    EXPERIENCE:

    One or two years experience in a hospital Admitting/ED Registration Department with emphasis on registration, third party insurance verification and financial clearance dealing with all aspects of medical insurance and eligibility requirements preferred. Prior customer service experience required.

    SPECIAL_SKILLS:

    Excellent interpersonal skills and leadership ability. Has the ability to effectively communicate with all disciplines and all levels of customers. Strong working knowledge of PCs and related software to prepare a variety of reports. Must be able to work under constant pressure and use strong organizational skills. Must have knowledge of third party insurance, financial clearance, eligibility, billing & reimbursement, cash collection. Ability to interpret federal/state regulations and various governmental program guidelines (including free care). Demonstrates working knowledge of Medical Terminology. Bilingual (Spanish-speaking) ability is preferred.
    ACCOUNTABILITY:

    the accuracy and timeliness of patient registration, patient admissions and discharges; the completeness of all required documentation involved in pre-certification, insurance verification and financial clearance of patient accounts. Obtains the necessary demographic, clinical and financial information to ensure that patients are admitted and/or registered properly in adherence with established departmental guidelines, hospital policies and medical staff by-laws as it pertains to all of the functions. Relates federal/state regulations and governmental program guidelines throughout the free care application process.
    COMPLEXITY:

    Position requires application of a variety of policies and procedures in dealing with employees, patients, families, physicians and their staffs. Due to the complexity and diversity of the interaction with various disciplines, must have the ability to assess situations and make sound judgments in rectifying issues. Due to the ever-changing healthcare industry environment, must have the ability to understand how changes affect patients and hospital reimbursement, as well as the overall impact to the registration operation. Must be capable of independent judgment in dealing with clinical staff, patients and families. Maintains a variety of statistical reports to track quality assurance, customer service and employee productivity.
    PHYSICAL_DEMAND:

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    Job Info

    Job: 2621

    Department: Access Representatives
    Category: Pt Fin Admit Svc
    Status: Full Time
    Shift: DAY/EVENING
    Hours: 40.00