This position will function as a team lead or supervisor and provide day to day direction and oversight to Patient Access Services , as well as be a resource to all staff on highly complex PAS issues and problem resolution . This position is responsible for completing the financial clearance process within Patient Access and creating the first impression of WTH's services to patients , families , and other external customers . This position assumes responsibility for collecting and documenting information on behalf of the patient . The PAS Representative Level III will also work with medical staff , nursing , ancillary departments , insurance payers and other external sources to assist families in obtaining healthcare and financial services .
Leadership -Develops schedules to ensure adequate staffing on all shifts to facilitate effective and efficient Patient Access Services operations.
Provides day to day work assignments, oversight and leadership to staff and works with the department management to set standards, develops and executes improvement plans.
Assists with providing hands on training to new employees and working with existing employees who require retraining or need to learn a new aspect of their job.
Alerts management of any backlogs in processing and provide suggestions for resolution.
Coaches and mentors less experienced team members on all aspects of the revenue cycle, payer issues, policy issues, or anything that impacts their role.
Reviews and resolves accounts that are complex and require a higher degree of expertise and critical thinking.
Performs daily accuracy reports and quality assurance reviews of patient accounts as directed.
Responsible for obtaining complete and accurate demographic, financial, and clinical information to help ensure maximum reinbursement for the hospital.
Provides input and assistance to PAS management in developing and implementing policies and procedures.
Registration - Performs financial clearance process by interviewing patients and collecting and recording all necessary information for pre-registration and registration of patients.
Ensures that proper insurance payer plan choice and billing address are assigned in the automated patient accounting system. Verifies relevant group/ID numbers.
Completes the registration process according to established policies and procedures.
Ensures patient receives necessary disclosures, privacy information and signs the relevant documentation.
Financial Clearance - Contacts payers to verify insurance eligibility. Completes automated insurance eligibility verification, when applicable and appropriately documents information in the patient accounting system.
Determines the patient's insurance type and educates patients regarding coverage and/or coverage issues.
Informs families with inadequate insurance coverage regarding financial assistance through government and financial assistance programs.
Performs initial financial screening and refers accounts for financial counseling and/or appropriate eligibility assessments.
Ensures all referrals and treatment authorizations for all patient types have been obtained according to the outlined requirements. If not obtained, contact payers for approvals.
Completes initial medical necessity checks, refers to designated area if medical necessity fails or if referrals /authorizations are denied.
Collect co-payments, co-insurance, and deductibles according to pre-service/ point of service collections policies and procedures.
Communication & Miscellaneous - Advises next-level leader of possible postponement or deferrals of any elective/non-emergent admission which has not been approved prior to service date.
Maintains accurate files for pre-processing information as required.
Assists with cross training function in areas within Patient Access services.
Performs related responsibilities as required or directed.