Patient Access Representative I – On-Call (Westside)

The Patient Access Representative I is a unique role within the Kaiser Permanente Health System environment. The Patient Access Representative I welcomes the patient into the care delivery setting and initiates the administrative systems that will lay the groundwork for the patient-s clinical care as well as the financial documentation. The Patient Access Representative I is responsible for ensuring a complete and accurate Patient admission/registration. Responsibilities include but are not limited to: collecting pertinent registration data, performing functions such as limited insurance eligibility and benefits verification, point of service cash collection, based on established manual or technological protocols, and completion of documentation necessary for the expedient registration/ admission of Patients according to organizational policy and procedures and federal/state/regulatory requirements. Obtaining inpatient bed assignments and processes inpatient admission, including direct admit, to include following patient identification protocols and completion of necessary documentation. Refers patients to Financial Counselors for Medical Financial Assistance. Answers and/or refers questions received from patients, visitors, staff as appropriate. Performs various related cash handling procedures per SOX control regulations. This position acts as an ambassador to ensure a patient friendly experience. The Patient Access Representative I has knowledge of state and federal regulations governing patient healthcare encounters and assures compliance. The Patient Access Representative I facilitates the patient and family care experience and aids them in understanding the Kaiser Permanente Healthcare System facilities and routines. The Patient Access Representative I works closely with both the financial team (Patient Business Services and the payor(s)) and the clinical team (nursing, physicians, hospital supervisors, etc) to ensure the optimum patient experience, accurate registration, maximum cash flow and reimbursements for the system. This position is an intermediate level position that requires a professional service-oriented individual with strong organizational skills working under limited supervision. The work environment at times can be stressful, pressured, or hostile. This position works on the front line with constant patient interaction in high volume registration areas and the Emergency Departments. Work situations are varied and require an individual with the ability to respond to patients and families with compassion, respect, and understanding. This position requires strong organization skills, prioritization, good judgment, diplomacy, and independent thinking. Internal contacts include physicians, staff and management throughout the organization, including, but not limited to, Patient Business Services, Patient Access Representative II and III, Utilization Management, Patient Flow Coordinators / HAS, and Health Information Management. External contacts include patients, families, community physicians, and outside organizations such as representatives from government agencies and allied hospitals. Independent decision-making is required in daily routine functions. Major decisions are subject to review and approval. Essential Functions: – Greets & registers patients for various medical services in the hospital setting potentially in a 24 hour, 7 day a week environment & in a highly active fast paced setting such as the Emergency department. Pre-registers patients where applicable. – Completes comprehensive bedside or telephone interviews with Patient, relative, or their representative to obtain pertinent demographic information, insurance data and/or third party liability information. – Performs minimal eligibility verification & resolves discrepancies as able or defers to appropriate resource, identifies need for financial assistance recommendation & application, referring to the Financial Counselor where necessary. – Verifies the patient demographic & insurance information with the patient consistent with CMS regulations, the National Registration Standards & regional policies. – Verifies members eligibility & benefits from identified insurance plan(s) prior to or upon admission to the hospital, using computer based verification programs, as available. – Uses problem-solving skills to verify patient identification through patient name, spouse names, SSN, DOB & address in order to identify & minimize duplicate medical records – Interview patient to obtain/determine appropriate insurance carrier & identifies, verifies, & inputs Other Coverage Information (OCI), primary, secondary, & tertiary payers for services provided. – Performs registration function for all patient class & clinical services. – Determines & collects cost-shares, & partial payments for services to be received. Enter/verify payments in the computer, close cash drawers, count currency, checks, & credit card payments at the end of each shift, & create deposits per cash handling policies. – Provides patient liability information & collects the point of service cash from patients based on guidelines and/or systems provided by the department, including but not limited to: co-payments; deductibles; co-insurance; deposits; outstanding balances. – Communicate to the patient the Northwest-s policy on payment of services or prepayment when significant patient liabilities are identified. – Refers, as appropriate, to financial counselors. – Interacts with Patient Business Services/Membership Services personnel regarding status of accounts as necessary to respond to questions/concerns related to registration requirements. – Documents all activity pertaining to patient’s account in the system. – May schedule and/or cancel right type of appointment based on member-s needs & regional protocol. – If applicable, makes return appointments. – Completes regulatory or policy required forms, to include payor requirements such as Medicare, L & I requirements & some commercial payors, & obtains all necessary signatures via mail, pre-admit, pre-op visit or upon admission/ registration. – Makes copies of patient identification, insurance information & other related forms & documents, electronically scan capture where appropriate. – Understands & adheres to the rules & regulations of Medicare, Medicaid, Managed Care & Commercial payers regarding referrals, preauthorization & pre-certification requirements. – Is knowledgeable & maintains compliance with CMS by accurately completing Medicare Secondary Payer screening information to determine primary payor. – Receives physician orders and, if applicable, performs medical necessity check using automated system. – Interprets basic healthcare system-s regulations & policies for patients & patient families consistent with the defined scope of work. – Knowledge of MOAB training requirements for managing aggressive behavior. – Maintains an understanding of HIPAA privacy & security regulations with respect to Patient confidentiality & regulations that govern system use for patient registration requirements. – Understands & adheres to EMTALA regulations & the relevance for patient registration & patient liability collection in the Emergency Department General Services. – Stocks appropriate forms & supplies; takes out used supplies. Demonstrating responsibility in handling supplies & equipment in a cost-effective manner & according to standards such as policies, procedures, & infection control guidelines. – Assist patients by providing specialty phone numbers, facility directions & office layouts; directing to other departments & administrative services for further information, for example (but not limited to) Membership Services, Dental & Pharmacy. – Escorting patients to area of service. – Initiates safekeeping & return of Patients- valuables in accordance to hospital policy when required. – Provides information assistance to Patients, visitors, & the public regarding general hospital policies & procedures. – Interacts with patient’s physician regarding status of hospital account/registration issues & refers as needed. – Provides patients- demographic information/insurance plan updates to physician offices or other medical services, such as EMT services where appropriate. – Responsible for maintaining records during system downtime & performs recovery processes. – Maintains accurate statistical records of departmental activities as needed, for data gathering within the UBT work teams. – Performs all other duties as assigned consistent with job description.

Qualifications:
Basic Qualifications: Experience – One (1) year health care financial AND one (1) year office environment customer service OR two (2) years post high school related education OR combination of education and experience. – Previous experience with cash handling required. Education – High school diploma/GED. License, Certification, Registration – CPR required. – Basic Medical Terminology certificate. Additional Requirements: – Must obtain training and Medical Terminology certificate within 180 days if existing Patient Access Employee or has proof of completed Medical Terminology course, outside applicant must have upon hire. – Obtains training and becomes CPR Certification within 30 days if existing Patient Access Employee or has proof of current CPR Certification, outside applicant must have upon hire. – Ability to type minimum 35 wpm with above average accuracy. – Excellent communication skills with all types of individuals. – Excellent organizational and written skills, flexibility and ability to switch tasks frequently. – Ability to operate CRT, IBM compatible PC, Windows, such as MS Word/Excel, copier, fax, phone, and headset. – Job requires continuous reading skills and the ability to handle a heavy volume of work. – Working knowledge of basic medical terminology, diagnostic related groupings, diagnosis and common procedure terminology to determine benefits and estimate service cost. – Knowledge of Medicaid, Medicare, and other government and insurance/payor requirements. – Knowledge of basic State and Federal regulations governing healthcare encounters, such as HIPAA, State worker’s compensation, third party liability for accidents, EMTALA and etc. – Knowledge of and skill in the use of automated Patient care systems for admissions, registration, and basic medical records functions (registration systems). – Knowledge of basic state and federal regulations regarding funding resources. – Knowledge of organization’s and/or facility based billing systems. – Knowledge of department procedures and established confidentiality policies. – Knowledge of communication techniques with ability to listen actively and respond to fellow employees/customers in a timely, competent manner both verbally and non-verbally. Preferred Qualifications: – Previous experience with EPIC applications preferred. – Previous hospital or ambulatory clinic registration experience preferred. – One (1) year higher education preferred. – Certification by HFMA or NAHAM preferred. – Obtains training to become a Certified Healthcare Access Associate by the National Association of Healthcare Access Management within 180 days of employment preferred.