PATIENT ACCESS ADVOCATE I
Employment Type : Full-Time
Overview: Type of Opportunity: Per Required Need
FTE: 0.001000
Exempt: No
Work Schedule: Varied Days and Hours
Summary:
The Patient Access Advocate I provides primary registration of patient accounts for self-pay, government and commercial accounts on date of service for scheduled and unscheduled visits. Perform registration functions, including updating of demographics, insurance verification, collection of point of service liabilities and documentation of registration information within the ADT system. Confirm account being registered has accurate information to ensure clean billing. Must possess basic knowledge of Medicare (CMS) guidelines, as well as other Compliance Regulatory guidelines applicable to Patient Access. Provide the highest level of customer service to patients/family at time of service through registration interactions as well as providing wayfinding to patients and/or visitors.Responsibilities: Customer Service and Caring Practices:
- Ability to provide exceptional patient experience for patients and patient families by using CARES, AIDET and EPE tools.
- Addresses and attempts to appropriately resolve complaints in the moment by using key words at key times and de-escalation processes.
- Ability to manage conflict and appropriately request the help of a supervisor when needed.
- Implement PROMISE and CARES behaviors in every encounter.
- Educates patients for whom they speak regarding insurance benefits and liabilities.
- Ensures accounts are financially cleared at time of service through account review. to alleviate patient concerns over hospital financial matters
Encounter Components:
- Performs the patient registration process. Manage the accurate collection of patient data which includes but is not limited to;
- Obtain/confirm and enter demographic and other financial information, not obtained during pre-registration/financial clearance process, necessary for account completion.
- Obtain missing insurance information, to include policy number, group number, date of birth, and insurance phone number if not already identified in account.
- Verify insurance for eligibility and benefits using online electronic verification system or by contacting payer directly.
- Accurately document actions taken in the system of record to drive effective follow-up and ensure an accurate audit trail.
- Maintain ongoing knowledge of authorization requirements and payer guidelines. Maintain a knowledge of Medicare (CMS) guidelines as it relates to admissions and outpatient services. Ensuring compliance with admissions forms, benefit entitlement verification, and billing requirements.
- Ensure accurate completion of MSPQ at time of service if not completed during financial clearance process.
- Daily focus on attaining productivity standards.
- Monitor and track Data Quality program to ensure errors are corrected at time of service. .
- Maintain appropriate records, files, and timely and accurate documentation in the system of record.
Other duties as assigned
Financial Accountabilities:
- Collects identified patient financial obligation amounts including residual balance if applicable. Collect liability from patient at time of service.
- Educate patients on financial assistance, charity or other programs that may be available.
- Refers as appropriate to on site Financial Advocate or to the Financial Advocacy Center
Patient Relations:
- Complete any information missing from the account to ensure accuracy at time of visit.
- Transparency with patients through communication of patient liabilities.
Quality Improvement:
- Perform assigned patient care responsibilities, which may include but not limited to:
- Cooperate fully in all risk management activities and investigations.
- Report promptly any suspected or potential violations to laws, regulations, procedures, policies, and practices, and cooperate in related investigation.
- Conduct all transactions in compliance with all company policies, procedures, standards, and practices.
- Demonstrate knowledge of all applicable compliance and legal requirements of the job based on the scope of practice of the position.
C.A.R.E.S Behaviors:
- Demonstrates CARES behaviors of Collaborate, be Accountable, Respect, Engage and Serve to all whom you encounter.
Qualifications:- 6 months experience in healthcare setting or 1 year customer service background.
- Pass 2 week Patient Access Academy with a passing score of 85% or higher (within 6 mos of start).
- CHAA, CHAM or other industry equivalent certification preferred
- Basic understanding of insurance preferred.
- Basic understanding of medical terminology and billing codes (DRG, ICD-10, CPT, HCPCS) preferred
- Requires basic understanding of registration and healthcare.
- Basic knowledge in Microsoft Office Products
Education:
Essential: * High School Diploma or GEDBenefits: Benefits are effective day-one (for .45 FTE and above) and include:- Competitive salaries
- Full medical, dental and vision insurance
- Flexible spending accounts (FSAs)
- Free wellness programs
- Paid time off (PTO)
- Retirement plans, including matching employer contributions
- Continuing education and career development opportunities
- Life insurance and short/long term disability programs
About Us
Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees. Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans.
We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.
About New Mexico
New Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great.
Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC.
New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.