Patient Access Coordinator

Acts as resource person for staff on their shift and insures smooth operation of the area.   Obtain and verify appropriate personal, demographic and financial information for the purposes of ensuring (1) Quality patient care through proper patient identification and (2) maximal reimbursement for all billable clinical services rendered.  Performs all Department functions as needed.  Delegate workflow duties per assignment indicated on Daily Placement.

Responsibilities

Education and Leadership Skills 

Provides education and training/mentoring for other staff members. Conducts and attends department meetings and reviews procedural & process changes per facility specific guidelines.

Assist and clear accounts for billing from WQ’s established.   

Ensures new associate orientation is completed.

Must present positive role model.  Facilitates Performance Improvement processes.  Responsible for staffing issues during on call coverage.

Interviews patients and obtains and verifies appropriate personal demographic and financial information for the purposes of ensuring:  (1) quality patient care through proper patient identification and (2) maximal reimbursement for all billable clinical services rendered.   Assesses and updates information as it relates to each encounter. Determines financial plan and coverage priority.  

Analytical Skills

Analyze patient accounts; evaluate financial data for Establishment of current accounts and documents comments to reflect actions taken regarding accounts to maximize reimbursement Prioritize organizations participation in insurance contracts.   Maintain knowledge of current HMO/PPO/Medicaid/Medicare/commercial insurance regulations and requirements.   Requires working knowledge of Insurance Plans the Christ Hospital participates in.  Determines all insurance coverage’s as primary, secondary, tertiary, etc.  Completes required MSPQ questionnaires for all appropriate patients.  Obtains and documents clinical referrals from other providers. Coordinates Patients in need of financial assistance to pay for present and/or future services to appropriate Financial Counselor.   Collects and deposits according to specified protocols, all required and mandatory insurance co-payments.

Initiates on-line verification of third party Insurance Carriers and Plan Administrators to verify patient benefits. Evaluates and prepares chart documentation to establish that Medical Necessity guidelines have been met.  Prepares and completes documentation that establishes Medicare Compliance such as Medicare Secondary Payor Questionnaire and Advance Beneficiary Notice.  Documents appropriate data in Account Doc and guarantor notes.  Prepares daily census statistics, reconciles patient days and patient type changes.