Job Information
Virginia Mason Franciscan Health Patient Access Rep in Lakewood, Washington
Overview
In 2020 united in a fierce commitment to deliver the highest quality care and exceptional patient experience Virginia Mason and CHI Franciscan Health came together as natural partners to build a new health system centered around the patient: Virginia Mason Franciscan Health. Our combined system builds upon the scale and expertise of our nearly 300 sites of care including 11 hospitals and nearly 5000 physicians and providers. Together we are empowered to make an even greater impact on the health and well-being of our communities.
Responsibilities
This job is responsible for performing a variety of general administrative support duties associated with the patient intake process for the Franciscan Medical Group (FMG) outpatient clinics in accordance with established internal guidelines and procedures. Incumbents typically interact with patients directly at the front desk and/or on the phone to perform follow-up activities.
Work includes: 1) ensuring patient is checked in/out for care; 2) collecting and entering demographic and financial data in the patient’s medical record; 3) gathering/validating insurance information using routine methods, scheduling patient appointments; 4) collecting co-pays, co-insurance and prior balances; 5) obtaining and processing of referrals, authorizations and pre-certifications for patients requiring ancillary testing and/or surgical procedures; and 6) working with patients to ensure the patient’s referral needs are fulfilled and determining insurance benefit coverage for hardware related items such as retail contact lenses by working directly with patients’ insurance carriers, ever needed.
Work requires critical thinking, hearing the needs of the patient meeting those needs by offering multiple options and solutions, knowledge of insurance authorization/billing requirements and privacy/confidentiality practices, as well as knowledge of medical terminology and the patient intake process. An incumbent following proper channels of communication in handling daily and routine problems and recognizing issues that need referral to management. Strong customer service skills are required offering the highest level of service to every patient every time.
An incumbent is generally located either behind-the-scenes, interacting with patients on the phone or at the front desk, interacting with patients directly.
Registers and/or checks patients in/out.
Performs patient check-in at the time of visit; records and verifies all demographic, insurance and other information (e.g. Workers’ Comp, other third-party liability info); follows established procedures to ensure that all registration guidelines/requirements have been satisfied, including ensuring minors’ guardians have been notified; identifies deficiencies and resolves non-complex issues or escalates to appropriate staff for further action.
Conducts routine insurance eligibility verifications.
Copies/scans patient access related hardcopy materials (e.g. ID, referrals, L&I, insurance cards, etc.) into correct location in electronic medical record.
Records non-clinical charges from various sources. This could include entering charges for the completion of forms, for Depositions/Attorney Fees, for retail fees, etc.
Handles and reconciles payments.
Collects appropriate co-payments, co-insurances, and other fees/monies due, including cash payments (in accordance with FMG Business Office Cash Handling Procedures); posts payments to patient accounts.
Collects payments at the time of check-in or check-out where appropriate.
Performs end-of-day payment reconciliation; balances and closes out cash drawers; ensures that outstanding tasks are completed and that preparation work for the next day’s clinic is completed or assigned to other staff.
Continually monitors and reconciles issues prior to patient visit.
Researches to identify and reconcile remaining issues before patients arrives for their appointment.
Makes registration and other front-end corrections.
Ensures that all missing/erroneous/incomplete information is updated.
Ensures that all insurance eligibility checks are conducted where possible.
Resolves edits in the work queues.
Processes referral orders and/or pre-authorizations.
Ensures that insurance eligibility checks have been conducted on all referrals before the patient is seen, either by escalating to the Insurance Verifier, or by directly checking on eligibility.
Completes referrals and/or pre-authorization, before the patient is seen, for diagnostic testing, therapy, surgeries, procedures and specialty care according to requirements and patient preference.
Provides information to patients regarding their health care plan; interprets and communicates plan policies and procedures to employees, physicians and members (patients).
Provides patients with answers to billing and insurance clarification questions; obtains a cost estimate when requested, and explains insurance benefit coverage to patient.
Notifies physician(s) and patient when referral is denied or if a second opinion or additional info is needed.
Updates the patient’s medical record as necessary. Copies/scans documents into correct location within electronic medical record.
May interact with referring clinic to ensure successful coordination of patient care.
Coordinates appointments and ancillary services.
Schedules patients for multiple providers and clinics if assigned to Call Center work unit.
Coordinates patient clinic visits based on authorized referral in accordance with established standards and procedures; gathers and documents insurance eligibility data, conducting routine verifications that can be done quickly during conversation; enters data in patient’s electronic medical record as appropriate.
Identifies patients requiring contact to confirm a referral appointment; contacts patient in accordance with established procedures.
Contacts and follows up with patients to reschedule a missed/cancelled appointment; documents reason(s) for no-show in accordance with established procedures; notifies management if patient has violated a policy and further action is required.
Makes arrangements for addressing special/ancillary patient requirements, including transportation, interpreters and other needs relating to patient care and satisfaction.
Responds to patient questions regarding routine billing and insurance matters.
- Provides basic information in response to patient questions on billing and insurance matters; obtains a non-complex cost estimate when requested; refers questions regarding more complex cost estimates/benefits information to Financial Counselor.
Coordinates patient instructional/educational activities.
Works with clinic team, patients and/or employers to ensure that patients receive adequate instructions and information regarding educational opportunities relevant to the patient’s referral; provides information to patients regarding their referral appointment and service for testing, financial policies, registration requirements, etc.
Provides patient with pre-visit prep materials; packages materials to correspond with type/nature of patient appointment and sends to patient in a timely manner
Coordinates materials/rental equipment: coordinates purchase of materials for a referral and the rental of medical equipment; follows up with patients when equipment return is due.
Qualifications
Education/Work Experience Requirements
- One year of customer service work experience is required, two years preferred. Healthcare or Call Center experience preferred.
Job Knowledge/Abilities:
Knowledge of clinic referral and scheduling processes and insurance billing/authorization requirements.
Knowledge of clinic financial options, payment alternatives and insurance billing/authorization requirements.
Knowledge of federal and state payor requirements, including Medicare, DSHS, HMO/PPO Contracts.
Knowledge of the meaning and usage of medical terminology, abbreviations and coding protocols (e.g., ICD-10) sufficient to perform the duties of the position.
Knowledge of the functionality and use of automated registration and billing systems (e.g., Cerner) sufficient to perform the duties of the position.
Ability to learn and ensure compliance with all state and federal regulatory insurance mandates, laws and policies (e.g., WAC, HIPAA, CMS, WSHA) as appropriate within designated scope of authority.
Ability to read, understand and accurately apply new regulations, business contracts, policies, procedures and technical manuals as appropriate within designated scope of responsibility.
Ability to rapidly prioritize tasks with accuracy and consistency, and to perform multiple activities simultaneously.
Ability to communicate effectively and to maintain strict confidentiality of information.
Ability to read and understand English sufficient to perform the duties of the position.
Ability to use office equipment and automated systems/applications/software at an acceptable level of proficiency.
Ability to establish and maintain effective working relationships as required by the duties of the position.
Pay Range
$17.93 - $26.76 /hour
We are an equal opportunity/affirmative action employer.