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.
This position supports the Yale Pediatric Specialty Clinic and is responsible for scheduling, pre-registration, registration, insurance verification, authorization ,WQ maintenance, patient check-in & facilitation of patient throughput for multiple pediatric specialty physicians at the GH location. The average yearly volume is 4347 visits with an anticipated increase in volume to 7463 visits per year( see attached business plan). This position will also assist in coverage for the hours of operation for this service area.
Functions as the patient representative responsible and accountable for coordinating the activities of the patient account from the point of initial contact through account resolution. Formulates solutions to respond and resolve non-clinical customer requests, issues and problems, while meeting the changing demands and priorities of the hospital and third party environments. Works closely with the patients, families, outside departments and third party payers to ensure compliance to individual requirements to expedite the timely collection of the accounts receivable and protect the patient and the Hospital from unnecessary financial loss.
1. ACTS AS A PATIENT REPRESENTATIVE ? Works closely with patients and/or family members to insure all demographic and insurance information is accurate and complete while also responding and resolving non-clinical customer requests, issues and problems. 1.1. Establishes a relationship with the patient and their family to identify and address financial issues, assuming responsibility for the patient's account from pre-admission/registration through the account's resolution. Works and accurately ensures the completeness of the account based on department benchmarks. 1.2. Responsible to review and interpret various regulatory programs as they are instituted. Make suggestions to operationalize and implement in order to not only ensure compliance to regulations but also to protect the patient from unnecessary penalties and financial responsibility. 1.3. Explains financial matters to Care Coordinators, Social Workers, nursing staff and the patient/family including charges and billings for Hospital services. Determines estimates and patient balances due and makes arrangements for their timely collection. 1.4. Answers any patient concerns or complaints regarding the admitting, registration, billing and accounts receivable process before, during and after services. Refers any non-financial issues to the appropriate designated clinical individual and follows up as necessary. 1.5. Through detailed investigation, identifies potential financial assistance needs and coordinates the initiation of payment plans, MedCard applications and inquiry into various state and federally funded programs such as Medicaid and Free Care. Ensures the application process is initiated as dictated by City, State, and Federal regulations. 2. COORDINATES ACTIVITIES OF ACCOUNT - Coordinates patient account from point of initial contact through account resolution, focusing on the collection of prepayments (Pre Reg, Ambsurgs, Inpatient, and complex radiology procedures). 2.1. Coordinates the efforts of the pre-registration, verification, billing and follow up aspects on accounts. Serves as the point of contact for the patient and their family on insurance and other financial matters. Identifies problems of eligibility for admission, treatment and discharge, and utilizes problem solving skills to ensure appropriate follow up and resolution are accomplished. 2.2. Contacts the patient/family to obtain demographic and financial information, inform them of their benefits, collect appropriate co-pays, deductibles and coinsurances and obtain appropriate signatures to ensure the completeness of the account. 2.3. Monitors the patient account through the admission and discharge process, ensuring all proper authorizations and pre certifications are obtained so that appropriate reimbursement is achieved. Acts as the single resource for the patient for all insurance clearance, verification, billing, and reimbursement problems that occur, serving as their liaision to the billing and collection process. 2.4. Ensures appropriate financial documents such as payment agreements, medical releases and important message from Medicare forms are signed, documented and scanned into the system. 2.5. Adheres to all SBO standards for the billing and collection of the accounts receivable. Enters all financial and demographic data into the computer systems and maintains accurate financial records. 3. PROMOTES SERVICE EXCELLENCE & THE PAR CONCEPT THROUGHOUT THE ORGANIZATION ? Works with hospital and health system staff throughout the organization to coordinate patient admissions in a way that exhibits service excellence and protects the patient and Hospital from unnecessary financial loss 3.1. Provides educational information regarding third party requirements to patients, family members and other hospital staff as necessary. Maintains department incentives focused on enhancing the patient's experience. 3.2. Assists in the training and refresher training of new and existing employees. 3.3. Conducts in-services and presentations to other hospital departments and outside agencies to promote the PAR concept through out the organization and ensure the needs of the patient and hospital departments are being met. Assigned to actively participate on various task forces and committees on issues affecting patient through put and the overall business operations of the department. 3.4. Ensures patient satisfaction with the PAR system through identification of opportunities for the improving quality of services. Participates in departmental committees which influence or recommend policies affecting the admission/registration process. Involved in the identifying and follow through of service recovery needs. 3.5. Attends courses offered in order to improve personal growth and the overall effectiveness of the area. 4. USES A VARIETY OF SOFTWARE APPLICATIONS, REPORTS AND STATISTICAL DATA - Uses available computer systems to accomplish tasks and aid in the completion of the account. 4.1. Confirms eligibility and identifies problems of eligibility for inpatient admissions and other hospital services, ensuring that appropriate action is taken to resolve. 4.2. Researches information as needed to insure all patient demographic and financial information entered is accurate and all downstream systems are updated and in sync. 4.3. Maintains a working knowledge of Word, Excel and Power Point software in order to track statistical data and trends in the operational workflow and prepare presentations as needed.
High School Diploma or General Education Degree (GED)
Two to three years in an Access related environment or medical customer relations background. Patient interviewing and hospital medical insurance and third party experience preferred.
Must be self directed and well organized with excellent interpersonal and team oriented skills. Strong working knowledge of computers, word processing & spreadsheet software. Ability to exercise good decision making and independent judgment. Excellent oral and written communication skills and analytical skills necessary.
Incumbent held accountable for coordinating all of the financial aspects of the patient's accounts while maintaining a high level of customer satisfaction. Must be available to work flexible shifts to meet patient needs including weekends and alternating holidays.
Requires dealing with a variety of situations, exercising discretion and independent judgment in dealing with patients/families and hospital staff. Formulates solutions to resolve complex problems while meeting the changing demands and priorities of the hospital and third party environment. Identifies need to modify the work flow as needed to respond to redesigns in the delivery of health care and its accompanying reimbursement issues that have significant financial impact to the institution. Ability to utilize PC software programs and other systems to monitor and track patient account activity while coordinating the financial needs of the patient.