Patient Access Associate II - Central Financial Clearance - 40hrs

Under general supervision, coordinates and performs multiple complex functions within the Patient Access department. Utilizes judgment to interpret department policies to resolve routine to complex inquiries/patient account problems with other departments. Identifies opportunities for process improvements and offers potential solutions. 

Participates in meetings as a representative of the department. Serves as a resource to team members for training, problem resolution, etc. Performs all duties in a manner that promotes a team concept and reflects the mission, behaviors, core values and philosophy of CT Children’s Medical Center.

Administrative:

• Following department protocol provides general receptionist, secretarial support, or Health Unit Coordinator functions. 
• Performs a variety of administrative support activities in support of the unit operations.
• Responds with tact and discretion to the needs of patients and families. 
• Maintains privacy and confidentiality. 
• Assists with staffing assignments and scheduling as requested.

Registration:

• Collects and enters accurate demographic, guarantor and financial data for Emergency Department, Inpatient and Outpatient cases and Physician Practice Office appointments. 
• Verifies all required insurance and billing information and uses the proper payer plan codes. 
• Generates all necessary forms for patient visit and obtains patient/parent/legal guardian signature for Assignment/ Authorization and consent. 
• Performs pre-registration for scheduled patients and registers patients upon arrival adhering to standard department procedure. 
• Makes corrections and updates patient information in computer systems as necessary. 
• Asks patients/families whether their visit was satisfactory and attempts to address any questions/issues prior to patient departure.
• Documents thorough, clear, explanatory notes regarding reasons for incomplete information at time of registration. Documents concise and understandable comments regarding patient or guarantor interaction, efforts to collect co-payments and referrals to Financial Assistance.
• Follows-up on open items to resolve outstanding issues and complete the file.
• Reviews all documentation records regarding incomplete information at time of registration, patient or guarantor interaction, efforts to collect co-payments, estimated self-pay balances and referrals to Financial Assistance.  
•  Follows up with team member responsible for resolving the open issue to provide assistance or additional training to ensure prompt completion of the file. 
• Reviews and works assigned work queues for registration information to ensure that accounts are accurate at time of visit and or billing.

Scheduling:

• Schedule complex appointments either in person or via telephone
• Creates/inputs complex department provider appointments.
• May schedule/coordinate appointments with other areas of the hospital.
• As a first line representative of CT Children’s, this person must have the ability to deal compassionately and professionally with patients and families.

Front Office (Check-In):

• Arrives patients for their appointment in the ADT system.
• Verifies demographic and insurance information at time of arrival (including securing patient financial liability at time of service).
• Check out process including scheduling or rescheduling future appointments.
• Answer telephone and triage calls for the department.
• Ensure all consent and privacy forms are signed.
• Work directly with DCF to obtain appropriate signatures/legal guardian information.
• Enters routine to complex patient charges into billing system for physician or care provider visits, according to protocol.
• Other front office duties as required.

Financial Clearance:

• Responsible for various work queues of scheduled and/or non-scheduled appointments.
• Communicates with insurance companies to obtain benefits, referrals, and/or authorization requirements.
• Communicates with Clinical/Office staff of patient eligibility, authorization status, and need for clinical documentation.
• Completes chart reviews to submit all appropriate documentation to insurance companies for authorization purposes.
• Coordinates with third party payers regarding information necessary for appropriate financial processing of patients, including: follow-ups with primary care providers for referrals and authorizations; notifying insurance carriers of admissions; obtaining authorizations and verifying benefits eligibility.
• Refers patients/families to Financial Counseling for updated and/or eligibility issues.
• Works directly with RN, APRN, and MD level staff to notify of denials requiring further action.
• Coordinates with Utilization Review for status designation of Outpatient/Inpatient Admissions.

Financial Counselor:

• Interviews patients to verify complete insurance and financial information, explain financial policies, complete appropriate financial evaluation forms.
• Refers patients/ families to DSS and Financial Assistance.
• Determines guarantor’s propensity to pay non-covered charges, as well as determine potential eligibility for financial assistance programs.
• Establishes financial arrangements / payment plans with patients.
• Identifies reason(s) for non-payment and follows-up to ensure resolution.

Financial Responsibility:

• Verifies insurance plans using the various methods available such as RTE, Web-Based, & Telecommunications.
• Investigates patient insurance coverage, facilitates certification, manages process to maximize payment from both commercial and managed care plans. 
• Follows-up with team member responsible for patient account to resolve outstanding financial issues.
• Demonstrates knowledge of the age-related differences and needs of patients in appropriate, specific populations from neonate through adolescence and applies them to practice. 
• Demonstrates cultural sensitivity in all interactions with patients/families. Demonstrates support for the mission, values and goals of the organization through behaviors that are consistent with the CT Children’s STANDARDS  

Education and/or Experience Required:

• High School Diploma, GED, or a higher level of education that would require the completion of high school, is required.
• 5-7 years directly related experience preferred; Healthcare experience required.

Education and/or Experience Preferred:

• Associates Degree preferred.

License and/or Certification:

Required:  None

Preferred:  CHAA (Certified Healthcare Access Associate).

Knowledge, Skills and Abilities:

Knowledge of:

• Intermediate knowledge of MS Word and Excel.
• ADT systems and Insurance Verification systems (EPIC preferred).
• Knowledge of Managed Care, referral/pre-certification/ authorization process.
• HIPAA.

Skills:

• Computer, typing, data entry.
• Excellent telephone and communication skills.
• Strong organizational skills.

Ability to:

• Handle a fast paced, high-volume environment,
• Work in a team environment alongside multiple disciplines.
• Provide guidance and assist in training to peers. 
• Have crucial conversations with others/ peers.