Patient Access Rep (BGH)

Beacon Health System; Granger (IN); On-site; USD 36,000 - 54,000; Full time

Job summary

Beacon Health System is seeking an patient registration professional to admit and register patients for services in a professional and courteous manner. You will collect co-pays, verify insurance, and balance cash while maintaining regulatory knowledge for accurate reporting and billing.

The role involves coordinating eligibility, pre-certification, and documentation, and requires attention to detail, strong communication, and the ability to work with multiple hospital departments.

Qualifications

• Requires a high school diploma or equivalent; CHAA certification is highly preferred.
• Associates degree is preferred and may be beneficial for advancement.
• Experience in hospital/medical office settings is preferred; knowledge of medical terminology helps communication.

Responsibilities

• Verifies insurance coverage and network status to determine patient benefits.
• Audits insurance eligibility using the Relay Connect dashboard.
• Verifies network eligibility for potential transfers (Transfer Direct).
• Obtains VOB information: co-payment, deductible, and year-to-date amounts.
• Obtains pre-certification information and follows up with physicians as needed.
• Registers patients and collects co-payments/deductibles; completes documentation for timely claims.

Skills

Typing 40 wpm

Telephone skills

Interpersonal skills

Verbal communication

Confidentiality

Cash handling

Education

High school diploma or equivalent

Associate's degree preferred

CHAA certification preferred

Tools

Pathways Healthcare Scheduling

RelayHealth

Cerner

Job description

Reports to the Registration Manager or the Registration Supervisor. Follows established Memorial Hospital of South Bend (MHSB)/Beacon Granger Hospital (BGH) policies and procedures to admit and register patients for services in a professional and courteous manner. Is responsible for accurate and complete registration of all MHSB/BGH patients. Must maintain regulatory and functional knowledge of all information required which ensures timely and accurate reporting/billing. Collects applicable co-payments and deductibles and completes insurance verification and must be able to accurately decipher eligibility responses and relay that information back to the patient. Performs daily cash balancing procedures. Obtains all required signatures on paperwork and performs clerical duties as necessary.

MISSION, VALUES and SERVICE GOALS

• MISSION: We deliver outstanding care, inspire health, and connect with heart.
• VALUES: Trust. Respect. Integrity. Compassion.
• SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.

Registers Patients (in Order To Obtain Demographic, Physician And Insurance Information In Accordance With Established Departmental Policies And Procedures) And Collects Applicable Co-payments And Deductibles By

Coordinates the insurance eligibility and pre-certification/documentation (PA) processes for patients by:

• Verifying insurance coverage and network status by using online eligibility systems and websites to determine the patient's benefits under the insurance plan.
• Audit insurance eligibility by using the Relay Connect dashboard to verify insurance is eligible and correct.
• Verify network eligibility for potential transfers for Transfer Direct.
• Obtaining VOB information from the insurance company, such as: co-payment, co-insurance, deductible, the amount of the deductible that has been met year-to-date, family deductible, maximum out-of-pocket limit and rehabilitation benefits.
• Obtaining pre-certification information from the insurance company's pre-certification unit (i.e., whether pre-certification is required, if the ordering physician has completed it, etc.).
• When the ordering physician has not completed the pre-certification, calling the physician's office to initiate the pre-certification process and following up until it has been completed.
• When the ordering physician has completed the pre-certification, documenting the authorization and releasing the account.

Coordinates Other Patient Services And Performs Clerical Duties By

• Preparing patient statistics (i.e., percentages) regarding completed demographic information as requested by the Director and/or Manager.
• Processes utilization review emails and physician orders to complete change patient types in Star.
• Works mismatch report to ensure that all patient types match the level of care order.
• Printing itemized bills for the patient upon receipt of co-payments or coinsurance (if requested).
• Entering authorization number in the appropriate field for proper and timely claims filing.
• Calculating co-payments and coinsurance for services rendered per the insurance companies' request.
• Processing and filing reservations, pre-testing forms and testing results in an efficient manner.
• Process faxes from nursing units, diagnostic departments, ClaimAid, and social services to update patient information, add insurance, and register add on patients.
• Answering the telephone and communicating information in an appropriate manner according to approved MHSB standards and departmental policies and procedures.

Notifies the appropriate area of the patient's arrival and ensures that the patient is escorted to the appropriate location by:

• Notifying the assigned Unit of the patient's arrival.
• Preparing the patient's chart, ID band and labels for the medical record.
• Arranging for an escort to assist the patient to the assigned outpatient area or to the patient's room (by wheelchair or by walking with the patient).

Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by:

• Providing world class service at all times.
• Assisting the department to meet or exceed its quality assurance goals.
• Greeting and providing information to patients and their families in a professional and friendly manner.
• Acting as a representative of Memorial Hospital of South Bend/Memorial Health System and striving to make a good first impression.
• Striving to accurately process an optimal number of registrations (or pre-registrations) during one's shift.
• Communicating with the Manager (or Director) regarding any concerns or problems.
• Maintaining records, reports and files as required by departmental policies and procedures.
• Performing time of service collections effectively by achieving assigned collections goals and maintaining strong patient relations.
• Completing other job-related duties as assigned.

Organizational Responsibilities

Associate complies with the following organizational requirements:

• Attends and participates in department meetings and is accountable for all information shared.
• Completes mandatory education, annual competencies and department specific education within established timeframes.
• Completes annual employee health requirements within established timeframes.
• Maintains license/certification, registration in good standing throughout fiscal year.
• Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
• Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
• Adheres to regulatory agency requirements, survey process and compliance.
• Complies with established organization and department policies.
• Available to work overtime in addition to working additional or other shifts and schedules when required.

Education and Experience

The knowledge, skills and abilities as indicated below are acquired through the successful completion of a high school diploma or equivalent is preferred. Must be a minimum of 17 years of age. A minimum of one year of previous hospital or medical office experience is preferred. A medical terminology course must be successfully completed during the first year of employment. Additional college-level courses in the medical practices area are desired. Associate's degree preferred. CHAA certification is highly preferred.

Knowledge & Skills

• Requires basic office and keyboarding skills (with the ability to type a minimum of 40 wpm) and the ability to use designated reference materials and office equipment (i.e., computer, printer, fax machine, calculator, etc.).
• Requires effective telephone skills (for example, to accurately take and relay information about patients, physician orders and referrals).
• Demonstrates proficient computer skills (i.e., data entry, word processing and spreadsheets). Requires the ability to use multiple databases (such as Pathways Healthcare Scheduling, RelayHealth, Cerner and MCA Compliance Checker).
• Requires a complete understanding of time-of-service collections. Specifically, must understand why it is necessary and must be able to effectively communicate this to MHSB/BGH patient community as necessary.
• Requires basic knowledge of medical terminology, private insurance coverage (and managed care).
• Demonstrates the interpersonal skills necessary to interact effectively with patients from various backgrounds in a professional, enthusiastic, courteous, friendly, caring and sincere manner. Also demonstrates the ability to maintain effective working relationships with other departments, physicians and their office staff.
• Demonstrates the verbal communication skills needed to communicate in a clear and effective manner when conducting patient interviews, answering patients' questions and communicating with other departments and physician offices.
• Good listening skills are required. Sensitivity to individuals who do not speak English as their first language is expected.
• Requires the ability to strictly follow MHSB/BGH policy on confidentiality. Also requires the ability to be aware of the need to lower one's voice in certain situations.
• Requires ability to utilize good judgment and maintain one's composure in stressful situations.
• Requires the basic math skills needed to successfully balance a cash drawer.

Working Conditions

• Works in an office environment. Also, may work in patient care areas with possible exposure to biohazards.
• Requires a flexible work schedule (including evenings, nights and weekends) that meets the needs of the Department.
• Must be effective in a quality-focused, multi-priority environment that frequently deals with stressful situations and important deadlines and schedules.

Physical Demands

• Requires the physical ability and stamina (i.e., to walk moderate distances, climb stairs, lift up to 15 pounds, reach, bend, stoop, twist, etc.) to perform the essential functions of the position.