Patient Access Representative II Healthclub Novi Admin Full Time Days

Tenet Healthcare; Detroit (MI); On-site; USD 10,000 - 60,000; Full time

Job summary

Join a forward-thinking healthcare organization as a Patient Access Representative II, where you will play a vital role in ensuring patients receive the care they need. In this dynamic position, you will be responsible for managing patient registrations, resolving complex insurance issues, and providing essential support to patients navigating financial challenges. Your expertise will help streamline operations and enhance patient experiences, making a significant impact on the community's health services. If you are passionate about patient care and have a knack for problem-solving, this is the perfect opportunity for you to shine in a supportive and collaborative environment.

Qualifications

• 2-3 years of experience in patient access or hospital registration.
• Advanced knowledge of third-party payer requirements.

Responsibilities

• Resolve complex eligibility and insurance verification issues.
• Assist patients with financial counseling and payment sources.

Skills

Patient Access Management

Insurance Verification

Financial Counseling

Problem Resolution

Education

High School Diploma

Associate Degree (desired)

Job description

Job Description - Patient Access Representative II

Location: Novi, MI

Facility: DMC Rehabilitation Institute of Michigan

Employment Type: Full Time Days

Job Summary:

Under limited supervision, functions as a resource to Patient Access Representative I. Provides training and orientation on department methods, procedures, and policies. Provides input for establishing departmental policies and procedures. In conjunction with Lead, resolves complex eligibility or insurance verification problems through contacts with patients or patient families, state or government agencies, other hospital departments, and third-party payers. Assists Financial Counselor with financial counseling services to help patients in identifying and obtaining payment sources.

Resolves complex and/or sensitive issues and recommends appropriate actions. Participates in bed management as defined in operating unit policies and procedures. Verifies insurance coverage and benefits, obtains and analyzes necessary authorizations and referrals, and calculates estimated patient liability. Reviews, monitors, and reconciles patient accounts to ensure accurate bill production. Ensures compliance with third-party payer requirements. Registers and schedules patients for health services ensuring appropriateness of setting for services provided. Explains appropriate forms to patients and families and ensures that necessary consent, regulatory forms, and MSP questionnaire (if applicable) are completed correctly and that patient signatures are obtained.

Obtains accurate insurance, medical, and demographic data to admit or pre-admit patients to the health facility. Verifies insurance coverage and benefit levels with various third-party payers and analyzes authorization and referrals, calculates estimated patient liability. Determines patient co-pays/deductibles and collects payment as outlined in hospital policies.

Assists patients without medical insurance coverage in completing medical assistance applications and/or making payment arrangements and cash collections.

Coordinates scheduling of all tests and/or services utilizing current clinical guidelines. Develops a liaison relationship between patients and the health facility by answering patients' questions regarding health facility policies and billing procedures and by obtaining necessary information to efficiently register and accurately bill for services rendered.

Assists patients in completing necessary forms and obtains patient signatures as needed. Collects referrals and authorizations; attempts to secure telephone referrals if necessary.

Completes telephone registrations as appropriate. Resolves bill holds in a timely manner to ensure completion within 5-day bill hold reconciles and corrects any rejected transactions on user-specific Transmission, Control, and Errors (TCE) reports. Assists and participates in special projects as assigned. Communicates clinical, financial, and administrative information. Performs duties of Lead as requested. Performs other duties as assigned.

Qualifications:

1. High school diploma; associate degree in related area desired.
2. Two to three years of progressively more responsible experience in patient access, hospital registration, or related area.
3. Advanced knowledge of third-party payers' requirements, reimbursements, and co-payments/deductible collections.

Employment Practices:

Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status, or any other legally protected status.

Upon receipt of a conditional offer of employment, the applicant will be required to undergo a criminal background check.

Tenet participates in the E-Verify and Work Opportunity Tax Credit (WOTC) programs.