Patient Accounts Rep

Summary:

Under the general supervision of the Supervisor but according to established policies and procedures interviews pre-register/registers and admits patients. Financially clears accounts for Admission and other Ambulatory Departments by obtaining demographic third-party insurance and related financial information using LifeChart. Initiate review and follow-up on patient accounts to ensure proper data collection for billing reviews any existing account balances for previous hospital services requests cash deposit by approximating charges for scheduled services or co-payments or co-insurance if applicable. Arranges payment agreement and contacts the Patient Financial Advocates when applicable and makes preliminary determination on welfare eligibility and /or RIH Financial Assistance program. Verify all demographic and insurance information and obtains and/or applies for the referrals and/or authorizations from the payers as required by Hospital policies.

Responsibilities:
Interviews patients or patient representative in order to obtain complete and accurate personal and financial patient information; follow-up on missing data by interviewing patients families or calling employers nursing homes and other facilities.



Utilizes multiple systems to validate the accuracy of patients health insurance acquire authorization and patients financial liability.



Contacts patients/families to complete pre-admission demographic and financial information including patient copays deductibles co-insurance and outstanding balances. Completes Medicare Secondary Questionnaire Liability information etc. when applicable. Mail Welcome Brochure.

Validates patients insurance using Passport eligibility system phone calls to insurance company or payer web-site.

Obtains authorization for inpatients observation and selected outpatients.

Contact patient and physicians if payer denies authorization approval.

Reviews outpatient/observation pre-admission Medicare patients to ensure the patient class is appropriate following the Medicare status Cregulation. Follows up with physicians when applicable.

ABN Advance Beneficiary Notice validates for selected outpatient services for Medicare patients if services are covered. Works with physicians office to ensure accuracy of selected procedures.

In-house patients obtains appropriate authorization for patient class changes and visit patients on the nursing unit to explain changes in their financial responsibilities.

Follow up on all missing information and unsigned documents for ED Admissions by visiting patients on the nursing unit.

Meet with patients/families when Medicare patients have used all of their inpatient coverage days and can opt in or not to opt in to use their Lifetime Reserve Days. Make payment arrangements if they choose not to use their Lifetime Reserve Days.

Daily in-house patients with RI Medicaid or Mass Health insurance plan validate if they have a Managed Care product and obtain the authorization.

All in-house patients validate their insurance the first of each month.

Pre-Admission testing registration complete all necessary demographic and financial information for admission including necessary information for the admission welcome booklet and Advanced Directives. Completes Pre-Admission registration.

Direct Admission is completed on the Nursing unit by the Patient Account Representative.

Self-pay patients - refer to Medicaid Specialist/Patient Financial Advocate.

Completes waiver for Non-Covered Servicesfor Non-Medicare payers and No authorization at time of servicefor Non-Medicare payers.

Coordinate daily admission reports for payers.

Greet and direct all patients families and visitors in a prompt and courteous manner.

Arrive Admissions:

Scans identification (license etc.).

Takes patient photo.

Have patient agreement signed.

Explains to patient or designee the Patient Consent and/or Patient agreement and obtains all required signatures in accordance with the Admission/Registration policies to meet established hospital requirements.



Obtain any missing demographic financial information.

Reviews Passport eligibility response to ensure insurance is valid.

Provides and reviews with the patient or designee the HIPAA Privacy notice Ethics brochures Patient Rights Hospital Directory Advance Directives and the Rhode Island Hospital Welcome Brochure and other related information as developed.



Prepares patient ID bracelet and places on patient.

Explains waiver for Non-Covered Services and No Authorization at time of service when applicable.

Documents all information into LifeChart and follows the Over the Counter Policy by logging payments and provides receipts per department policy.



Utilizes the LifeChart system and the Business Office reports to complete daily work. Communicates with service departments to obtain MD order information as required.



Utilizes department equipment and the following systems and policies related to these systems LifeChart Account Maintenance Hospital Balance Query My Virtual Merchant Payer Web Sites Passport Workbrain Flight Tracker Work Ques Faxes Netlearning SafetyNet and Valuables Log.



Completes other duties as required.

General Responsibilities



Attends and participates in staff meetings.

Protects and preserves patients right to privacy and confidentiality.

Other duties as assigned.

Other information:
BASIC KNOWLEDGE:

A level of knowledge generally obtained through completion of High School.



Well developed interpersonal and communication skills in order to obtain patient information and communicate effectively with the public at point of contact or via phone.



Ability to respectfully set payment arrangement terms and collect payments.



Knowledge of third party health insurance authorization/validation.



EXPERIENCE:

Preferred Epic ADT/Cadence and/or Billing experience.



Two year minimum experience in a hospital physician setting or health insurance company.



WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:

Working conditions are generally good in a normal working environment.



SUPERVISORY RESPONSIBILITY:

N/A