Role Description The Patient Access Representative verifies demographic and insurance information, completes coordination of benefit changes, calculates patient estimates, verifies the accuracy of the surgery prior authorization, and collects patient financial obligations. The individual utilizes a complex skill set and verifies every scheduled patient surgery and is ultimately responsible for assisting patients and families. Works as a member of a team to ensure reimbursement for services in a timely and accurate manner. Essential Functions - Confirm valid coverage for services and location by contacting insurance companies and/or reviewing electronic responses for benefit information. - Manage patient insurance demographic information to verify authorization obligations. - Verify that service is a covered benefit based on knowledge of the specific insurance plan, specific benefit package restrictions, and timing of the service. - Understand patient deductibles, out of network referrals, and out of pocket limitations. - Review the account and timing of the last patient demographic query to identify missing standard and/or required information. If necessary, contact the patient to complete the information. - Calculate and collect patient liability before or at the time of service. Communicate the liability and explain the calculation low and high amounts when necessary. - Identify the potential need for assistance when the coverage/benefit is either inadequate or nonexistent for a medically necessary service, and if necessary, create a payment plan with the patient and document the agreement appropriately. - Answer automated call center calls and determine whether an outbound call is necessary, either to the patient or to the insurance company. For a call back, assess the call and respond appropriately, attempting to resolve all patient inquiries. - Build strong working relationships with assigned business units, hospital departments, or provider offices. Identify trends in payment issues and communicate with internal and external customers as appropriate to educate and correct problems. Provide assistance and excellent customer service to these internal clients. - Respond to incoming calls and make outbound calls as required to resolve billing, payment, and accounting issues. Provide assistance and excellent customer service to patients, patient families, providers, and other internal and external customers. - Perform all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provide all customers with an excellent service experience by consistently demonstrating core and leader behaviors each and every day. Qualifications - High school diploma/GED or equivalent working knowledge. - Requires knowledge of one or more of the following: patient financial services or collecting service processes normally acquired over up to two years of work experience. - Requires the ability to manage multiple tasks simultaneously with minimal supervision and to work independently. - Requires strong interpersonal, oral, and written communication skills to effectively interact with a wide range of audiences. - Strong knowledge in the use of common office software, word processing, spreadsheet, and database software are required. Preferred Qualifications - Work experience with the Company’s systems and processes is preferred. - Previous cash collections experience is preferred. - Additional related education and/or experience preferred. Physical Demands/Environment Factors - Typical Office Environment: Requires extensive sitting with periodic standing and walking. - May be required to lift up to 20 pounds. - Requires significant use of personal computer, phone, and general office equipment. - Needs adequate visual acuity, ability to grasp and handle objects. - Needs ability to communicate effectively through reading, writing, and speaking in person or on telephone. - May require off-site travel. Supervisory Responsibilities - None Directly Reporting - Reports to the Supervisor – Patient Access Scope and Complexity - Works independently under general supervision, following defined standards and procedures. - Reports to a Supervisor or Manager. - Uses critical thinking skills to solve problems and reconcile accounts in a timely manner. - External customers include all ambulatory surgery center patients, patient families, and all third-party payers. - Internal customers include facility medical records and patient financial services staff, attorneys, and central services staff members.