Patient Assistance Representative- PRN

Job Summary and Scope

Register and/or admit patients to Sandoval Regional Medical Center. Obtain and enter into the system all information necessary to create a complete and accurate patient account. Ensure that appropriate and necessary notifications are made to insurance carriers or agencies. Advise, inform and assist patients before, during and after their date of service. Ensure adherence to Hospitals and departmental policies and procedures. No patient care assignment.

Essential Functions:

• POLICIES AND PROCEDURES - Maintain established departmental policies and procedures, objectives, and quality assurance programs
• PROFESSIONAL DEVELOPMENT - Enhance professional growth and development through participation in educational programs, reading current literature, attending in-services, meetings and workshops.
• Interview patients and/or family at time of pre-admission, registration, admission, or discharge to obtain accurate demographic and financial information. Update information on Hospital computer system to ensure correct billing.
• Schedule any new or follow up appointments
• Obtain proper signatures for Medicare Rights, Consent for Treatment, financial assistance forms, and other forms as appropriate. Assure that the Patient Rights statements are distributed.
• Verify insurance eligibility and restrictions to include referrals, prior authorization and financial assessment as required, may process patient discharge to include obtaining referrals, scheduling tests and other related activities.
• Verify insurance and benefits; provide notification to appropriate payer entities within time frames established by the payers.
• Obtain prior authorizations for same day surgery and other outpatient surgery patients as needed.
• Acquire the appropriate ICD-10-CM code and medical history documentation required to obtain the prior authorization.
• Update all hospital systems with correct information, calculate the co-payment for the service and collect out-of-pocket balances from the patient prior to service.
• Determine eligibility and process applications for financial assistance, including but not limited to; Medicaid, SCI, SRMC programs, Commercial, Medicare, PHS/Indian Health Service, SALUD and Self Pay.
• Maintain knowledge of community financial resources and refer patients appropriately.
• Answer phones and assist walk-in patients as needed.
• Assist with special projects and assignments.
• Perform miscellaneous job-related duties as assigned.

SRMC Core Values

Integrity: Our words and actions match our values

To Serve: We put the needs of others before our own

Excellence: We strive to exceed expectations and/or standards in every activity, every encounter, and every initiative

Safety/Quality: We provide evidence based care, programs, services, and an environment that achieves the best outcomes

Teamwork: We enjoy the ability and power to work collaboratively to deliver exceptional service

Accountability

• Position doesn’t have the scope of decision making, budget, assets and planning responsibilities.

Communication Skills

• Skill to communicate and interact with patients, families, physicians and staff
• Good written and verbal communication skills
• Ability to be aware of and sensitive to cultural and bilingual issues

Required Qualifications

• Knowledge of principles and processes for providing customer and personal services to pediatric, adolescent, adult and geriatric patients
• Knowledge of mathematics
• Skill in applying independent judgment
• Good organizational skills
• Ability to work effectively under stressful conditions and irregular hours
• Ability to interpret and assess data effectively
• Ability to multi-task and complete assignments
• Ability to be aware and respond to patient needs

Education/Experience

Education: High School Diploma or GED equivalent

Preferred Educational/Experience Requirements:

• Two (2) years registration, admitting, business office or related work experience
• Bilingual English/Spanish

Conditions of Employment

• Must pass a pre-employment criminal background check, reference checks and a post offer drug screen.
• Must be employment eligible as verified by the U.S. Dept. of Health and Human Services Office of Inspector General (OIG) and the Government Services Administration (GSA).
• Tuberculin Skin Test required annually
• Hospital required vaccinations
• Hospital required competencies

Working Conditions

• Typical office and/or patient care, acute care hospital environment.
• Must be able to travel locally between facilities and within the surrounding community.
• Occasional exposure to minimal physical risk
• Extensive travel
• Substantial overtime
• Evening meetings
• On-call status
• Exposure to contagious disease
• Exposure to chemicals
• Heavy lifting
• Constant standing
• Extensive close work
• Extensive computer work
• Dealing with hostile, upset people
• Dealing with grief and sorrow