Patient Access Representative II
Mount Sinai Medical Center, Miami Beach, FL, United States
Department: CC019042 Patient Access
Job Description Summary
Main Emergency Room on Miami Beach
Monday to Friday Evening Shifts: 3P-1:30P
Must be bilingual in Spanish
Position Responsibilities
Collects accurate and complete patient information (i.e.. legal name, permanent/local address, phone number, next of kin, employer, guarantor, insurance information, physician etc., and enters in the system within the established time frames).
Verifies insurance information, which include eligibility, benefits (i.e.. Deductibles, co-payments, out of pocket expenses, maximum lifetime coverage, exclusion/limitations/pre‑existing conditions, etc.) and obtains appropriate referrals, pre‑certification, and/or authorizations for all patient as follows: scheduled patients no later that 24 hours. Unscheduled patients at point of service within the established time frames.
Enters complete insurance verification information, which include eligibility, benefits (i.e.. Deductibles, co‑payments, out of pocket expenses, maximum lifetime coverage, exclusion/limitations/pre‑existing conditions, etc.) in the insurance verification screen and note fields.
Ensures that a copy of insurance cards, front and back, as well as a copy of a picture ID is obtained and scanned at time patient presents for service.
Provides and explains all registration documents (i.e.. General consent forms, Advance Directive information, Patient Rights information and Privacy Notice information).
After completion of registration process ensures that an identification bracelet has been placed on all patients.
After completion of registration process ensures all registration documents, as well as orders, accompany the patient to the appropriate area (i.e.. Nursing units, ancillary departments, etc.). Communicates all pertinent information regarding the patient to the appropriate departments / patient care units.
Prior to the end of shift conducts self‑audit of all registration to insure that information is accurate and complete, maintaining less than 5% error ratio. Forwards copies to immediate supervisor with supportive information of incomplete tasks.
Consistently demonstrates a clear understanding of departmental needs and job functions as assigned by department Manager and/or Team Leader.
Demonstrates full knowledge of Compliance Advisor's functionality as it relates to Medicare Compliance and accurately enters diagnosis according to prescription to check for ABN compliance.
Ensures that every registration has attached correct procedure, diagnosis (no R/O), printed physician's name and address on RX/referral and signature of doctor when indicated.
Assists patient in understanding his/her insurance benefits and explains hospital financial and deposit policies including up front collections and follows established guidelines for up‑front collections and collects and disburses revenue ensuring, at all times 100% accuracy of all ledgers and receipts, in accordance with established guidelines.
Maintains compliance of Patient Access processes and Federal State and Local Laws and regulatory standards (ACHA, HIPPA, Medicare, Medicaid, EMTALA, COBRA, etc.).
Demonstrates knowledge and proper use of RMS scheduling program.
Demonstrates knowledge and proper use of HPF and QCI.
Demonstrates knowledge and proper use of Avility Web MD and RTE applications.
Demonstrates flexibility as well as ability to perform multiple functions within the Patient Access department.
The individual is cross‑trained to perform duties across various areas of assigned tasks.
Verifies authorizations for service.
Qualifications
License/Registration/Certification
Not applicable
Education
High school graduate or equivalent level of training. Some college preferred
Experience
One year practical experience in computer usage. Three years' practical experience in registration, collections and insurance verifications preferred.
Benefits
Health benefits
Life insurance
Long‑term disability coverage
Healthcare spending accounts
Retirement plan
Paid time off
Pet Insurance
Tuition reimbursement
Employee assistance program
Wellness program
On‑site housing for select positions and more!
#J-18808-Ljbffr
Job Description Summary
Main Emergency Room on Miami Beach
Monday to Friday Evening Shifts: 3P-1:30P
Must be bilingual in Spanish
Position Responsibilities
Collects accurate and complete patient information (i.e.. legal name, permanent/local address, phone number, next of kin, employer, guarantor, insurance information, physician etc., and enters in the system within the established time frames).
Verifies insurance information, which include eligibility, benefits (i.e.. Deductibles, co-payments, out of pocket expenses, maximum lifetime coverage, exclusion/limitations/pre‑existing conditions, etc.) and obtains appropriate referrals, pre‑certification, and/or authorizations for all patient as follows: scheduled patients no later that 24 hours. Unscheduled patients at point of service within the established time frames.
Enters complete insurance verification information, which include eligibility, benefits (i.e.. Deductibles, co‑payments, out of pocket expenses, maximum lifetime coverage, exclusion/limitations/pre‑existing conditions, etc.) in the insurance verification screen and note fields.
Ensures that a copy of insurance cards, front and back, as well as a copy of a picture ID is obtained and scanned at time patient presents for service.
Provides and explains all registration documents (i.e.. General consent forms, Advance Directive information, Patient Rights information and Privacy Notice information).
After completion of registration process ensures that an identification bracelet has been placed on all patients.
After completion of registration process ensures all registration documents, as well as orders, accompany the patient to the appropriate area (i.e.. Nursing units, ancillary departments, etc.). Communicates all pertinent information regarding the patient to the appropriate departments / patient care units.
Prior to the end of shift conducts self‑audit of all registration to insure that information is accurate and complete, maintaining less than 5% error ratio. Forwards copies to immediate supervisor with supportive information of incomplete tasks.
Consistently demonstrates a clear understanding of departmental needs and job functions as assigned by department Manager and/or Team Leader.
Demonstrates full knowledge of Compliance Advisor's functionality as it relates to Medicare Compliance and accurately enters diagnosis according to prescription to check for ABN compliance.
Ensures that every registration has attached correct procedure, diagnosis (no R/O), printed physician's name and address on RX/referral and signature of doctor when indicated.
Assists patient in understanding his/her insurance benefits and explains hospital financial and deposit policies including up front collections and follows established guidelines for up‑front collections and collects and disburses revenue ensuring, at all times 100% accuracy of all ledgers and receipts, in accordance with established guidelines.
Maintains compliance of Patient Access processes and Federal State and Local Laws and regulatory standards (ACHA, HIPPA, Medicare, Medicaid, EMTALA, COBRA, etc.).
Demonstrates knowledge and proper use of RMS scheduling program.
Demonstrates knowledge and proper use of HPF and QCI.
Demonstrates knowledge and proper use of Avility Web MD and RTE applications.
Demonstrates flexibility as well as ability to perform multiple functions within the Patient Access department.
The individual is cross‑trained to perform duties across various areas of assigned tasks.
Verifies authorizations for service.
Qualifications
License/Registration/Certification
Not applicable
Education
High school graduate or equivalent level of training. Some college preferred
Experience
One year practical experience in computer usage. Three years' practical experience in registration, collections and insurance verifications preferred.
Benefits
Health benefits
Life insurance
Long‑term disability coverage
Healthcare spending accounts
Retirement plan
Paid time off
Pet Insurance
Tuition reimbursement
Employee assistance program
Wellness program
On‑site housing for select positions and more!
#J-18808-Ljbffr