Mercy Medical Center Clinton Patient Access Rep I in Ypsilanti, Michigan

Department:

AA101_69512 Patient Access Scheduling

Expected Weekly Hours:

20

Shift:

Day Shift

Position Purpose:

Under general supervision, responsible for performing the Patient Access Process components including scheduling, registration, and insurance verification. Interacts with patient and physician office staff to schedule basic radiology future services for patients including the coordination of multiple radiology services in proper sequence, as well as informing patient/doctor's offices of test preparations, insurance requirements, authorizations and financial responsibility for each service. Analyzes tests/procedures ordered with the signs & symptoms for the studies to make appropriate decisions regarding the services needed and the appointments required. Collaborates with multiple locations to best utilize resources, while accommodating physician preferences and patient needs. Speaks directly with departments to resolve numerous scheduling matters including STAT appointments, approvals, block times and appropriate selection of studies to schedule. Manages physician orders and other clinical documentation to ensure it is available and accurate for clinical staff at the time of patient service. Responsible for the complete and accurate collection of patient demographic and financial information to create the pre-registration episode. Verifies the patients’ insurance and source of payment and determines the coordination of benefits for scheduled services, as well as prevailing regulatory and 3rd party requirements.

Job Description Details:

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Interviews patients and physician office staff to obtain information and appropriately

  • schedule patients for future and same day basic radiology services using Cerner Enterprise Scheduling applications.

  • Interviews patients and gathers information to assure accurate and timely scheduling, registration, insurance verification and claims submission.

  • Interprets information collected to determine and create comprehensive patient and visit specific medical and billing records.

  • Determines need for authorization for treatment/procedures and coordination of benefits as required.

  • Utilizes multiple system applications simultaneously to complete the scheduling, order management, pre-registration and insurance verification processes including but not limited to Cerner Scheduling, Healthquest Patient Management and Patient Accounting, Powerchart, Freedom Imaging, Pathways Compliance Advisor, Emdeon Real Time Eligibility, Excel (was/is lists – order translation documents), Avaya CMS.

  • Provides information to patients concerning hospital policies and regulatory requirements utilizing exceptional interpersonal skills.

  • Obtains dates of previous services to determine eligibility for future services using Powerchart.

  • Uses prior study physician recommendations from Powerchart to determine appropriate next test to schedule.

  • Translates clinical information on physician orders to clinical order terminology to appropriately schedule patients for future services.

  • Responsible for scheduling STAT appointments, block appointments and obtaining department approvals for complex procedures.

  • Processes internet requests for scheduling services.

  • Ensures appropriate communication to patient requesting services.

  • Indexes incoming radiology physician orders using fax queue application (Freedom Imaging).

  • Provides assistance to other Health System or physician offices staff regarding registration information and procedures.

  • Determines appropriate payment required at point of registration (deposits and minimum charges for non-covered services). Using HealthQuest, pre-registers patients prior to clinical services. (Refer to job description for Patient Service Representative.)

  • Verifies insurance coverage using Real Time Eligibility for selected services to facilitate cash collection. Performs medical necessity screening for applicable services for Medicare patients.

  • Follow-up with patients and ordering physicians appropriately to communicate responsibility related to services found to be not medically necessary.

  • Responds to problems and questions from Medical Records, Clinical Departments or PFS Teams. Reviews, analyzes and corrects report entries to ensure accurate scheduling and registration, and makes sure insurance and billing requirements are met prior to services being rendered. Demonstrates understanding of prevailing regulatory and 3rd party requirements (MSP, authorizations, PCA, consent forms, ABN, etc.).

  • Assists patients or physician office staff by referring them to the appropriate sources of information. Identifies opportunities to improve the quality of scheduling, registration and/or verification processes.

  • Responds to patient questions concerning their scheduled services, registration, insurance eligibility and payment requirements as related to services they are scheduled to have.

  • Demonstrates accountability to follow-up with patients concerning requests for information of action regarding their appointment and/or account.

  • Knows where to obtain information to assist PFS team members, patients, and internal or external customers.

  • Demonstrates team-player abilities and seamless service to patients. Maintains good rapport and cooperative relationships.

  • Approaches conflict in a constructive manner. Helps to identify problems, offer solutions, and participate in their resolution.

  • Maintains the confidentiality of information acquired pertaining to patient, physicians, employees, and visitors to St. Joseph Mercy Hospital.

  • Discusses patient and hospital information only among appropriate personnel in appropriately private places.

  • Behaves in accordance with the Mission, Vision, and Values of Saint Joseph Mercy Health System.

  • Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.

REQUIRED EDUCATION, EXPERIENCE AND LICENSURE

Education:

Requires high school diploma or equivalent.

Preferred Experience:

One or two years related experience.

Preferred Certification:

Certified Healthcare Access Associate (CHAA through NAHAM)

REQUIRED SKILLS AND ABILITIES

  • Demonstrated computerized system application experience.

  • Critical thinking and problem solving skills.

  • Analytical ability to effectively and efficiently resolve registration, scheduling and insurance issues.

  • Demonstrated knowledge of the Revenue Cycle processes, components and terminology.

  • Exceptional interpersonal communication skills to effectively communicate with patients, team members, clinical colleagues, medical staff, external agencies and contacts.

  • Exceptional customer services skills and positive personality attributes.

  • Patience in dealing with ordinary, arduous or emotional patients.

  • Use of telephones and call center technology.

  • Ability to type at 35-40 WPM.

WORKING CONDITIONS

  • Call Center office environment.

REPORTING RELATIONSHIPS

  • Supervision provided by PFS Manager.

Trinity Health's Commitment to Diversity and Inclusion

Trinity Health employs more than 120,000 colleagues at dozens of hospitals and hundreds of health centers in 21 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.

Trinity Health offers rewarding careers in a community environment with all the advantages of working at one of the nation's largest health systems. We provide high-quality, people-centered care in 22 states through our network of hospitals, facilities, community-based services, and continuing care locations - including home care, hospice, Program of All Inclusive Care for the Elderly (PACE), and senior living facilities. If you are looking for a rewarding clinical or administrative position, you'll find exceptional career possibilities, opportunities for advancement and a job with meaning at Trinity Health.

Trinity Health employs more than 131,000 colleagues across 22 states. We honor and embrace a diverse representation of people, ideas and backgrounds. Our dedication to diversity is evident in our commitment to training, education, recruitment, retention and development, as well as community partnerships and supplier diversity.

Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences and health practices of the communities we serve and to apply that knowledge to produce positive outcomes. We recognize that each of us has a different way of thinking and perceiving our world, and that our differences not only serve to unite us, but also lead to innovative solutions.