Patient Access Representative 2 Full Time Bascom Palmer Eye Institute Miami, FL

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The University of Miami, Bascom Palmer Eye Institute, has an exciting full time opportunity for a Patient Access Representative 2 in Miami, Florida.

The Patient Access Representative 2 (On-Site) registers patients for clinical services by obtaining pertinent information, verifying insurance benefits, explaining pertinent documents, and collecting payments

• Obtains, confirms, and enters demographic, financial, and clinical information necessary for financial
• clearance of scheduled patient accounts.
• Contacts patients’ families or physicians’ offices to obtain missing insurance information.
• Verifies insurance and confirms insurance eligibility of patient coverage benefits, notifying patient and
• referring physician in the event of failed eligibility.
• Collaborates with scheduling departments to identify add-on patients.
• Obtains necessary authorizations, pre-certifications, and referrals.
• Notifies patients of liabilities and collects funds.
• Maintains appropriate records, files, and accurate documentation in the system of record.
• Adheres to University and unit-level policies and procedures and safeguards University assets.

• →UChart Office Assistant functions and monitoring of Provider’s In Basket Messaging
• →Processing of Back to Work or School Requests, and Immunization Records
• →Scanning Imaging Results
• →Preparing Charts/Medical Records
• →Processing of Medical Record Release of Information
• →Prescription Refill Requests
• →Test Results Requests
• →Treatment Plans
• →Appt. Reminder Calls
• →Bump Lists
• →Surgery Scheduling
• →Coordination of External Referrals
• →Promotion and Sales of Over the Counter Products
• →Inventory and Ordering of Supplies
• →Ordering of DME products
• →Bed Assignments
• →Pre-certifications

• →Exercise sound judgment so as not to delay treatment for emergency medical conditions and necessary stabilizing treatments, due to patient’s financial responsibility and collection efforts.
• →Determine and collect patient’s estimated financial responsibility for both POS 22 and POS 11 (i.e. deductible, co-payment, co-insurance, prompt payment discounts or global fee based on CPT/ICD9 codes).
• →Explain charges, fees, and previous balances for both technical and professional components.
• →Offer forms of payment including cash, checks, and credit cards.
• →Check for counterfeit bills when collecting cash and obtain authorization for all credit card transactions.
• →Post payment(s) as applicable for both POS 11 and 22, and issue system generated receipt(s).
• →Reconcile all collections and transactions at the end of the shift including initial cash bag funds.
• →Prepare daily deposit(s) for Med Finance, Main Cashier, or contracted armored pick up service.
• →Document any and all collection details including discounts, global fees and partial payments in system and select applicable billing indicators and FYI Global/Discount flags.

Education:

High School Diploma or equivalent/relevant experience, certification or license

Experience:

Minimum 2 years of relevant experience required

• Project a professional appearance and demeanor including appropriate body language and vocal tone.
• Immediately recognize and acknowledge internal and external customers in a welcoming, courteous and professional manner.
• Respect the privacy, dignity and confidentiality of our patients and be responsive to their needs by showing concern, empathy, patience and respect.
• Maintain composure during stressful situations and use sound judgment.
• Provide immediate service recovery by taking ownership of any problems that may arise and resolving them utilizing appropriate rationale.
• Provide patients with and interpret Patient Rights and Responsibilities.
• Reduce patient and family stress and increase patient satisfaction by actively participating in providing the best possible patient experience.

• Enter and/or update all pertinent data including demographics, financial, and referring physician information.

• Obtain legal photo identification and (if applicable) insurance card (s), and validate patient identity and coverage (if applicable) prior to services being rendered thereby ensuring patient safety and financial reimbursement.
• Scan ID, insurance card (s), advance directives, share of cost letters, and any other pertinent documents.

• Verify insurance eligibility and authorization requirements for walk-ins and add-ons utilizing multiple automated on-line resources or telephone.
• Identify point of service (POS) 11 versus 22 and obtain verification and referral/authorization accordingly.
• Provide patient/guarantor with detailed benefit and authorization requirements and co-pay, deductible, and co-insurance self–pay responsibility for POS 11 and 22.
• Ensure that the appropriate payer has been selected (i.e. Indemnity, HMO, PPO, POS, Auto, W/C, etc.) and that all the required data elements and referrals and authorizations based on CPT, ICD 9, and services being rendered have been obtained and accurately entered in system in order to avoid claim rejections.
• Refer non-contracted payers for single case negotiation.
• Determine appropriate filing order if patient is covered by more than (1) payer.
• Financially clear visits once insurance has been verified and referral/authorizations obtained.
• Generate HAR (Hospital Account Record) for all services rendered at a point of service 22 (POS 22), and assigns HAR’s to appointments accordingly.

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• Complete the Medicare Secondary Payer Questionnaire (MSPQ) at time of scheduling prior to services being rendered and in accordance with Centers for Medicare & Medicaid Services (CMS) Federal regulations.

• Utilize medical necessity software to determine if an Advance Beneficiary Notice (ABN) is applicable in order to produce and provide all Medicare patients with an ABN in accordance with CMS Federal regulations prior to services being rendered. Explain ABN in Study and Transplant
• Identify patients enrolled in a Study/Transplant program and validate that the account reflects the appropriate coverage(s) as it relates to the Study/Transplant program, in order to ensure accurate billing.

• Advise patients of financial obligations and collect according to established guidelines and financial policies.
• Identify alternate funding sources and offer global or discount.
• Identify patients which have been deemed eligible for charity care or financial hardship and determine if services being rendered are encompassed in charity approval.
• Assist patients in establishing payment plans.

• Determine upon checkout/discharge any pending financial responsibility, and collect and post payment(s) accordingly.

• Identify systematic warning flags/messages and populate required data elements in order to eliminate by- passed warnings/errors and avoid a negative impact on downstream revenue cycle processes.
• Monitor and clear patient work queues on a daily basis to ensure data integrity, prompt billing and minimal AR days.
• Populate any and all required data to ensure the checklist at the end of the arrival process reflects as complete for each category.

• Enter charge codes and amount of units accurately and within (1) business day of services being rendered.
• Perform daily reconciliation to identify missing charges and follow up with clinicians to obtain in order to ensure all rendered services are accounted for and billed.
• Maintain a 3 calendar day maximum lag in order to ensure prompt billing and increased cash flow.

• Review DAR and identify appointments that are not in completed status
• Contact clinicians to confirm appropriate status of each appointment.
• Update status accordingly (i.e. no-show, left without being seen, canceled, etc.).

• Excellent verbal and written communications skills in English. Bi-Lingual (English/Spanish, English/Creole, English/French, English/Arabic) a plus.
• Must possess excellent, critical thinking, analytical, troubleshooting, problem resolution, and customer service skills.
• Excellent mathematical and cash management skills.