The Admission Access Coordinator serves as a liaison between physician, hospital and patient regarding registration, admission and scheduling. This position requires population specific competencies. Adheres to National Patient Safety Goals as appropriate based on the level of patient contact this position requires.
The Admission Access Coordinator responsibilities include, but are not limited to, the following:
* Ensures excellent customer service by promptly greeting and answering patient/family questions and concerns in a positive manner
* Enters patients into registration and/or scheduling system accurately in a timely manner, verifies all previously obtained information, and initiates the pre-certification, pre-authorization and referral processes using multiple software and web pages to complete process following policies and guidelines outlined by individual departments and facilities as necessary.
* Responsible for meeting legal obligation to inform and educate patients regarding privacy laws, consent for treatment authorizations, financial contracts and advance directive rights and responsibilities; understands and interprets EMTALA, HIPAA and Fair Debt laws and practices
* Creates patient pre-registration account if necessary and verifies the procedure, surgery type (if required), physician and department schedule to ensure patient is promptly registered to initiate pre-certification process
* Refers uninsured or non-covered patients to the financial assistance team as appropriate according to policy.
* Analyzes insurance requirements for specific accounts based on knowledge of plan requirements for authorization, pre-certification, referral, and notification; understanding of insurance contracts, government health plans including Medicare, Medicaid, Indian Health and Workers Compensation and knowledge of guarantor rules, and accident/third party liability requirements
* Verifies insurance eligibility and interprets coverage and benefit levels; effectively communicates benefits and coverage to patients including collecting co-pays, co-insurance and deductibles
* Explains the billing process to patient and the office of their physician as it pertains to benefits and hospitalization if needed arranges payment options and refers the patient to the Patient Financial Advocate as appropriate
* Obtains appropriate releases and information; accurately identifies and verifies liable parties/insurance carriers by appropriate financial class and payor plan
* Collaborates to identify and rectify potential or actual barriers in meeting contractual obligations regarding pre-certification, referral, quality, and utilization review
* Adheres to all policies for collections, receipting, and handling of currency
* Achieves specific revenue cycle targets and goals as outlined in monthly performance scorecard maintaining accuracy requirements
* Ensures medicare medical necessity is met for scheduled or walk-in procedures by checking scheduled procedure and diagnosis codes against medicare local coverage determination policies and following the policies and procedures to mitigate risk to the organization if medical necessity check fails
* Safely transports patients by necessary means to appropriate location in a timely manner (Admitting only)
* Achieves specific revenue cycle targets and goals as outlined in monthly performance scorecard (Access Center Only)
* SMC only: Responsible for handling inpatient and outpatient bed placement through utilization of the hospital tracking system as well as communicating, the process with appropriate personnel. Responsible for recognizing the specific needs of diagnoses in regards to patient needs, doctor requests and levels of care offered by each floor. Maintains information on floor availability and overall hospital census as well as the inpatient bed log for permanent records and state and federal agencies.
Reports to the Department Director and/or Supervisor.
Required Physical Demands (Subject to Reasonable Accommodation):
Keyboarding/Dexterity: Frequently; activity exists from 1/3 to 2/3 of the time
Standing/Walking: Frequently; activity exists from 1/3 to 2/3 of the time
Strength (Lift/Carry/Push/Pull): Light (Exerting up to 20 pounds of force occasionally, or up to 10 pounds of force frequently)
Talking (Must be able to effectively communicate verbally): Yes
Color Acuity (Must be able to distinguish and identify colors): No
This position may have additional or varied physical demand and/or respiratory fit test requirements. Please consult the Physical Demands Project SharePoint site or contact Risk Management/Employee Health for additional information.
Potential for exposure to infections and communicable diseases, blood and body fluids, electrical equipment, chemicals. Must follow standard precautions.
INTEGRIS Health is an Equal Opportunity/Affirmative Action Employer.
All applicants will receive consideration regardless of membership in any protected status as defined by applicable state or federal law, including protected veteran or disability status.
Job Code: 1062
* High school diploma or equivalent
* 4 years of work experience in healthcare financial, managed care or medical assistance program OR 4 years of college coursework OR a combination of related work experience and college course work that equals 4 years.
* Previous experience in admitting, billing, or health insurance industry preferred
* Previous experience with Microsoft Office and Internet
* Previous experience with legal documents, full disclosure laws, credit analysis, and the fair debt collection practices preferred
* Must be able to communicate effectively in English