Under the general direction of the Patient Access Supervisor, Manager, and/or Director performs a variety of complex duties for the registration and advanced scheduling of patients for provider visits, medical and surgical procedures, tests and ancillary services.
Schedules patients for treatment and services for multiple providers within multiple clinics/departments/practices at multiple campuses utilizing scheduling rules or electronic guided scheduling protocols.
Coordinates the provision of multiple services to patients. Processes updates and corrections to patient insurance and demographic information. Obtains prior insurance referrals and authorizations. Collects patient liabilities prior to or on the date of service, as appropriate.
Arranges a variety of associated tests, procedures, and/or ancillary services according to established guidelines and specific criteria.
Applies relevant functional knowledge of multiple treatment areas, the priority and sequence of associated procedures, tests and primary care services.
Prioritizes visits and services in a manner that will foster more efficient utilization of physicians clinical staff, and patients time, as well as equipment and facilities.
Complies with referral management regulations established for primary care providers.
Enters patient registration/scheduling system, demographic, insurance and other related patient information into the computer system.
Obtains and verifies patient insurance coverage and follows guidelines established by insurers to ensure that pre-authorization, pre-certification, and physician referrals for treatment are obtained prior to patient visits. Follows up to correct discrepancies as required.
Telephones and/or notifies patient of appointment times. Provides patient with standard information regarding their personal preparation for scheduled procedures and services.
Mails patient information packets to patients.
Transcribes paper orders when applicable.
Assesses patients financial needs and directs accordingly to financial counseling, and refers to appropriate person or area.
Receives, and transfers patient phone calls to appropriate personnel and providers. Provides a variety of related clerical duties, such as retrieving medical and other records, faxing, collating, typing, transcribing, taking and relaying messages, etc.
Maintains accurate and timely records, logs, charges, files and related information as required.
Reviews work lists to ensure accurate and timely billing.
Recommends improvements in systems and procedures.
Collects patient liabilities including deductibles, copays, coinsurances, self-pay payments, cosmetic procedure payments, and patient balances as appropriate, prior to or on the date of service.
Monitors and maintains Patient Access and Revenue Cycle work queues.
Maintains scheduling and/or registration accuracy rate of 97% or above.
Maintains call center performance metrics according to department standards.
Performs holiday and/or weekend shift work, as well as after-hours coverage as required.
Meets established productivity standards.
Facilitates and promotes the sharing of knowledge and content throughout departments.
Takes responsibility for ensuring that all work outcomes satisfy the UMass Memorial Health System True North.
The individual must support the mission, vision, and goals of HealthAlliance-Clinton Hospital and serve as a role model for CARES values.
Adheres to change control processes.
Participates in cross training to optimize department resources.
Demonstrates excellent attendance and actively participates in a variety of meetings and training sessions as required.
Demonstrates a friendly, responsive, service-minded attitude to all internal and external customers.
Communicates ideas effectively. Shares information and keeps others properly informed. Gives, and is open to useful feedback.
Adheres to the HealthAlliance-Clinton Hospital Code of Conduct and Behavior Standards and dress code.
Complies with established environment of care/safety policies and procedures and all health and safety requirements.
Maintains and fosters an organized, clean and safe work environment.
Contributes to the development and application of process improvements.
Maintains a collaborative, team relationship with peers and colleagues in order to effectively contribute to the groups achievement of goals and to help foster a positive work environment.
Attends staff meetings and in-service programs as required or directed. Keeps current with hospital and unit changes by reading communication boards and/or books, bulletin boards, posted notices and reads and responds to e mails on a regular basis.
Practices cost containment and fiscal responsibility through the efficient use of supplies, equipment, time, etc.
Complies with established departmental policies, procedures and objectives.
Attends variety of meetings, conferences, seminars as required or directed.
Demonstrates use of Quality Improvement in daily operations.
Complies with all health and safety regulations and requirements.
Respects diverse views and approaches, and contributes in maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.
Performs other similar and related duties as required or directed.
All responsibilities are essential job functions.
High school diploma or equivalent.
Associates degree in business or healthcare-related field preferred.
Previous data entry experience in a medical facility, health insurance company or related area required.
English speaking, reading and writing skills required.
Strong interpersonal and communication skills needed.
3 years scheduling and/or phone customer services preferred.
Previous experience with insurance verification and/or authorization preferred.
Bilingual speaking, reading, and writing skills preferred.
Ability to use specialized applications software and computers systems for patient registration and scheduling. Ability to take directions and work independently. Demonstrated knowledge of business office products. Demonstrated knowledge of medical terminology.
Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.
Department-specific competencies, including age-specific competencies and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents.