Under general supervision, coordinates and performs multiple complex functions within the Patient Access department. Utilizes judgment to interpret department policies to resolve routine to complex inquiries/patient account problems with other departments. Identifies opportunities for process improvements and offers potential solutions.
Participates in meetings as a representative of the department. Serves as a resource to team members for training, problem resolution, etc. Performs all duties in a manner that promotes a team concept and reflects the mission, behaviors, core values and philosophy of CT Children’s Medical Center.
Administrative:
Following department protocol provides general receptionist, secretarial support, or Health Unit Coordinator functions.
Performs a variety of administrative support activities in support of the unit operations.
Responds with tact and discretion to the needs of patients and families.
Maintains privacy and confidentiality.
Assists with staffing assignments and scheduling as requested.
Registration:
Collects and enters accurate demographic, guarantor and financial data for Emergency Department, Inpatient and Outpatient cases and Physician Practice Office appointments.
Verifies all required insurance and billing information and uses the proper payer plan codes.
Generates all necessary forms for patient visit and obtains patient/parent/legal guardian signature for Assignment/ Authorization and consent.
Performs pre-registration for scheduled patients and registers patients upon arrival adhering to standard department procedure.
Makes corrections and updates patient information in computer systems as necessary.
Asks patients/families whether their visit was satisfactory and attempts to address any questions/issues prior to patient departure.
Documents thorough, clear, explanatory notes regarding reasons for incomplete information at time of registration. Documents concise and understandable comments regarding patient or guarantor interaction, efforts to collect co-payments and referrals to Financial Assistance.
Follows-up on open items to resolve outstanding issues and complete the file.
Reviews all documentation records regarding incomplete information at time of registration, patient or guarantor interaction, efforts to collect co-payments, estimated self-pay balances and referrals to Financial Assistance.
Follows up with team member responsible for resolving the open issue to provide assistance or additional training to ensure prompt completion of the file.
Reviews and works assigned work queues for registration information to ensure that accounts are accurate at time of visit and or billing.
Scheduling:
Schedule complex appointments either in person or via telephone
Creates/inputs complex department provider appointments.
May schedule/coordinate appointments with other areas of the hospital.
As a first line representative of CT Children’s, this person must have the ability to deal compassionately and professionally with patients and families.
Front Office (Check-In)
:
Arrives patients for their appointment in the ADT system.
Verifies demographic and insurance information at time of arrival (including securing patient financial liability at time of service).
Check out process including scheduling or rescheduling future appointments.
Answer telephone and triage calls for the department.
Ensure all consent and privacy forms are signed.
Work directly with DCF to obtain appropriate signatures/legal guardian information.
Enters routine to complex patient charges into billing system for physician or care provider visits, according to protocol.
Other front office duties as required.
Financial Clearance:
Responsible for various work queues of scheduled and/or non-scheduled appointments.
Communicates with insurance companies to obtain benefits, referrals, and/or authorization requirements.
Communicates with Clinical/Office staff of patient eligibility, authorization status, and need for clinical documentation.
Completes chart reviews to submit all appropriate documentation to insurance companies for authorization purposes.
Coordinates with third party payers regarding information necessary for appropriate financial processing of patients, including: follow-ups with primary care providers for referrals and authorizations; notifying insurance carriers of admissions; obtaining authorizations and verifying benefits eligibility.
Refers patients/families to Financial Counseling for updated and/or eligibility issues.
Works directly with RN, APRN, and MD level staff to notify of denials requiring further action.
Coordinates with Utilization Review for status designation of Outpatient/Inpatient Admissions.
Financial Counselor:
Interviews patients to verify complete insurance and financial information, explain financial policies, complete appropriate financial evaluation forms.
Refers patients/ families to DSS and Financial Assistance.
Determines guarantor’s propensity to pay non-covered charges, as well as determine potential eligibility for financial assistance programs.
Establishes financial arrangements / payment plans with patients.
Identifies reason(s) for non-payment and follows-up to ensure resolution.
Financial Responsibility:
Verifies insurance plans using the various methods available such as RTE, Web-Based, & Telecommunications.
Investigates patient insurance coverage, facilitates certification, manages process to maximize payment from both commercial and managed care plans.
Follows-up with team member responsible for patient account to resolve outstanding financial issues.
Demonstrates knowledge of the age-related differences and needs of patients in appropriate, specific populations from neonate through adolescence and applies them to practice.
Demonstrates cultural sensitivity in all interactions with patients/families. Demonstrates support for the mission, values and goals of the organization through behaviors that are consistent with the CT Children’s STANDARDS
Education and/or Experience Required:
High School Diploma, GED, or a higher level of education that would require the completion of high school, is required.
5-7 years directly related experience preferred; Healthcare experience required.
Education and/or Experience Preferred:
Associates Degree preferred.
License and/or Certification:
Required: None
Preferred: CHAA (Certified Healthcare Access Associate).
Knowledge, Skills and Abilities:
Knowledge of:
Intermediate knowledge of MS Word and Excel.
ADT systems and Insurance Verification systems (EPIC preferred).
Knowledge of Managed Care, referral/pre-certification/ authorization process.
HIPAA.
Skills:
Computer, typing, data entry.
Excellent telephone and communication skills.
Strong organizational skills.
Ability to:
Handle a fast paced, high-volume environment,
Work in a team environment alongside multiple disciplines.
Provide guidance and assist in training to peers.
Have crucial conversations with others/ peers.