Job TitlePatient Access Representative
DepartmentPatient AccessEvaluation Date
FLSA Statusnon-exemptColleague's Name
Reports ToSupervisor Patient AccessColleague's Signature
Approved ByMelissa MartinEvaluator's Name
Effective Date7/1/2018Evaluator's Signature
The primary function of the position is to greet, pre-register and/or register patients in a courteous and professional manner, verify insurance benefits and check for the necessity of pre-certification, authorization and referral. Perform medical necessity checks where needed. Secure patient signatures for required hospital forms and collection of patient's financial responsibility when required. The position is also responsible for providing professional, quality customer service, timely resolution to customer problems, and coordination of services to all customers. The position functions to communicate revenue cycle related issues to patients, physicians, physician office staff and other hospital colleagues. This position rotates into various areas of patient access and may work a variety of shifts.
Essential DutiesPerformance Rating
(1 - 5)
1Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
2Adheres to Corporate Compliance Guidelines
1. Understands and abides by HIPPA privacy and security laws and regulations.
2. Observes all applicable federal, state and local laws and regulations.
3. Observes all Mercy Health System and applicable subsidiary policies and procedures including the Code of Conduct.
4. Observes Mercy Health System Corporate Compliance policy by reporting any concerns about compliance or business practices to his or her immediate supervisor, appropriate management, Corporate Compliance Officer or Compliance Hotline.
5. Completes compliance related education
Performance Measures • Completes annual competency on Code of Conduct, HIPAA, and mandatories related to area of practice as assigned on Health Stream Online.
3Demonstrates knowledge and compliance with Hospital Safety and Infection Control policies as required by OSHA and the patient Safety Program.
1. Consistently demonstrates knowledge if universal precautions, isolation procedures, and other infection control measures.
2. Provides a safe environment for all patients, employees, and visitors.
3. Identifies safety problems encountered during the course work that if corrected may result in the prevention of accident/injury to patients, employees and visitors and reports problems to appropriate supervisor or the Patient Safety Hotline.
4. Adheres to System, Hospital and Department-specific safety programs.
• Medical / health care error reporting.
• Aware of sentinel events definition and reporting procedure.
• Completes annual patient safety fair training.
Performance Measures • Completes infection control modules as assigned on HealthSteam Online.
• Demontsrates 100% compliance with Hand Hygiene program.
• Required documentation in MIDAS is 100% accurate.
4Adheres to all Mercy Health System Policies and Procedures • Fully understands and complies
• Seeks information and clarity when unsure
• Complies with:
- Absenteeism Control Policy #60-06-10 and with established departmental "call-out" procedures.
- Lateness Control Policy #60-07-09 and with proper notification procedures
- Mercy Health System dress code policies
- Colleague Responsibility Policy #60-18-08 as well as all other Human Resources Policies.
- Review MHS policies and procedures, and references them accordingly when questions arise during the course of work for MHS
• Works with internal and external customers to efficiently and accurately enter patients into the hospital system, in accordance with departmental policies and procedures.
• Greets patients and pre-registers/registers patients promptly, professionally, and efficiently, in accordance with departmental policies and procedures.
• Follows the National Patient Safety Goals in regard to patient identification.
• Requests photo identification and copies of insurance card(s). Indicates in system when photo identification or insurance card(s) are unavailable.
• Follows red-flag identity protocols and report as required.
• Avoids use of medical jargon when speaking to patients and families.
• Collects and verifies all comprehensive personal, financial and medical information in an effective and courteous manner for the registration process.
• Reviews and updates the patient's account to ensure it has accurate and current information to process claims and obtain payment.
• Communicates to the patient the patient's financial responsibilities. Requests co-pay or deductible when applicable and provides receipt to patient.
• Explains forms and secures all patient signatures for required documents.
• Asks and answers question regarding Advance Directives.
• Ensures that all paperwork is sent to the appropriate departments.
• Provides assistance to patient/family in getting to clinical area.
• Answers phone utilizing proper Departmental Scripting.
• Speaks to patients/family members using age/culturally appropriate techniques.
• Recognizes potential changes related to aging and/or stress, i.e. diminished vision/hearing, decreased stamina, confusion, and intervenes appropriately.
• Notifies supervisor if children are alone in waiting areas.
• Contacts physicians or ancillary departments to resolve questions.
• Runs sanction checks on all ordering physicians not currently in doctor master, if necessary
• Performs all other duties related to patient registration as required to ensure a positive patient experience in accordance with departmental policies and procedures.
• Verifies and obtains insurance benefits and required referrals and pre-certifications for patients that have not been pre-registered before the patient is treated, immediately after the patient arrives, or, if necessary, within one business day of the patient's treatment
• Follows departmental policies and procedures for completing the patient's record, including copying insurance cards (or indicating in system when insurance card is unavailable), entering authorization/pre-certification/referral numbers, and other information as necessary
• Verifies insurance coverage through automated eligibility system. Uses insurance verification systems to verify eligibility and upfront collection amounts.
• Communicates and explains insurance benefits and coverage information to patients.
• Reviews patient accounts for financial status to identify non-funded patients and ensure referral to and appointment with a Financial Counselor. Notifies the Financial Counselor of all referrals.
• Collects monies for self-payment rates and documents system appropriately.
• Utilizes appropriate systems including Patient Accounting to research the patient's account history.
• Contacts the patient's insurance carrier to obtain benefits within 24 hours of the service date and determine if pre-certification or referral from Primary Care Physician is required.
• Refers inpatient accounts to Care Coordination for clinical justification for pre certification as necessary.
• Completion of IMM paperwork per CMS guidelines
• Maintains contact with physician practice offices to process insurance eligibility and pre-certifications
• Monitors insurance coverage to ensure patients are capitated to hospital.
• Ensures the patient has the required forms for Ancillary Services being rendered.
• If needed, directs patients to proper area for test.
• Ensures that patient has a signed and completed script for all services, with an ICD code.
• Performs medical necessity checks and follows up as necessary
• Verifies that a secured authorization and referral are on file if necessary
Customer Service and Problem Solving
• Meets the needs of the patient, physician, physician office, and internal colleagues by maintaining good public relation skills:
- Utilizes the AIDET model during every patient encounter (Acknowledge, Introduce, Duration, Explanation, Thank You)
- Strives to please the patient, physician, physician office, and internal colleagues at all times.
- Always greets the customer with a smile and addresses customer by name in a courteous, respectful and professional manner.
- Attempts to understand customer questions and concerns. If unsure of answer, seeks information from appropriate person in order to assist customer.
• Files all documents as needed.
• Identifies and solves client problems.
• Receives problem/question calls from clients, determines action needed, and monitors the problem to complete resolution.
• Addresses critical problems, otherwise communicates unresolved problems to the appropriate individuals as soon as possible.
ER Greeter/ER Registration:
• Properly and accurately registers patients utilizing legal name and date of birth and immediately issues patient identification bracelet at the end of the registration process.
• Completes quick reg process as required.
• Properly selects patients from the pre-registration status to complete the full registration.
• Registers patients using correct location.
Processes admissions in a timely and accurate manner to include service location.
• Maintains ongoing relationship with Care Coordination as required by departmental processes
• Continues to update and document in the registration record as information is received
• Completes status change in a timely and accurate manner and follows admissions process as required
Outpatient Greeter Duties:
• Answers the phone utilizing Departmental Scripting.
• Greets patient and logs patients into electronic tracking system.
• Directs patients to the appropriate testing area.
• Directs patient to registrar's office for registration.
• Ensures that the Outpatient Greeters desk is manned during defined hours of service.
• Ensures that the Outpatient Greeters desk is clean and neat and contains no protected health information that is accessible or visible to others.
12Other duties as needed and assigned by the manager.
13Adheres to applicable Federal, State, and local laws and regulations, Trinity Health's Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures.
Trinity Health's Commitment to Diversity and Inclusion
Trinity Health employs about 133,000 colleagues at dozens of hospitals and hundreds of health centers in 22 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.
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