Patient Access Representative I 12 HR-KSMC
Company: Kaiser Permanente Zion Medical Center
Posted on: March 19, 2023
The Patient Access Representative I is a unique role within the
Kaiser Permanente Health System environment. The Patient Access
Representative I welcomes the patient into the care delivery
setting and initiates the administrative systems that will lay the
groundwork for the patient's clinical care as well as the financial
documentation. The Patient Access Representative I is responsible
for ensuring a complete and accurate Patient
admission/registration. Responsibilities include but are not
limited to: collecting pertinent registration data, performing
functions such as limited insurance eligibility and benefits
verification, point of service cash collection, based on
established manual or technological protocols, and completion of
documentation necessary for the expedient registration/ admission
of Patients according to organizational policy and procedures and
federal/state/regulatory requirements. Obtaining inpatient bed
assignments and processes inpatient admission, including direct
admit, to include following patient identification protocols and
completion of necessary documentation. Refers patients to Financial
Counselors for Medical Financial Assistance. Answers and/or refers
questions received from patients, visitors, staff as appropriate.
Performs various related cash handling procedures per SOX control
regulations. This position acts as an ambassador to ensure a
patient friendly experience. The Patient Access Representative I
has knowledge of state and federal regulations governing patient
healthcare encounters and assures compliance. The Patient Access
Representative I facilitates the patient and family care experience
and aids them in understanding the Kaiser Permanente Healthcare
System facilities and routines. The Patient Access Representative I
works closely with both the financial team (Patient Business
Services and the payor(s)) and the clinical team (nursing,
physicians, hospital supervisors, etc) to ensure the optimum
patient experience, accurate registration, maximum cash flow and
reimbursements for the system. This position is an intermediate
level position that requires a professional service-oriented
individual with strong organizational skills working under limited
supervision. The work environment at times can be stressful,
pressured, or hostile. This position works on the front line with
constant patient interaction in high volume registration areas and
the Emergency Departments. Work situations are varied and require
an individual with the ability to respond to patients and families
with compassion, respect, and understanding. This position requires
strong organization skills, prioritization, good judgment,
diplomacy, and independent thinking. Internal contacts include
physicians, staff and management throughout the organization,
including, but not limited to, Patient Business Services, Patient
Access Representative II and III, Utilization Management, Patient
Flow Coordinators/HAS, and Health Information Management. External
contacts include patients, families, community physicians, and
outside organizations such as representatives from government
agencies and allied hospitals. Independent decision-making is
required in daily routine functions. Major decisions are subject to
review and approval. Staff members in this position may perform
all, or a combination of the duties described depending upon their
assigned work area and the specific needs of the department.
- Registration: Greets and registers patients for various medical
services in the hospital setting potentially in a 24 hour, 7 day a
week environment and in a highly active fast paced setting such as
the Emergency department. Pre-registers patients where applicable.
Completes comprehensive bedside or telephone interviews with
Patient, relative, or their representative to obtain pertinent
demographic information, insurance data and/or third party
liability information. Performs minimal eligibility verification
and resolves discrepancies as able or defers to appropriate
resource, identifies need for financial assistance recommendation
and application, referring to the Financial Counselor where
necessary. Verifies the patient demographic and insurance
information with the patient consistent with CMS regulations, the
National Registration Standards and regional policies. Verifies
members eligibility and benefits from identified insurance plan(s)
prior to or upon admission to the hospital, using computer based
verification programs, as available. Uses problem-solving skills to
verify patient identification through patient name, spouse names,
SSN, DOB and address in order to identify and minimize duplicate
medical records. Interview patient to obtain/determine appropriate
insurance carrier and identifies, verifies, and inputs Other
Coverage Information (OCI), primary, secondary, and tertiary payers
for services provided. Performs registration function for all
patient class and clinical services.
- Revenue Collection: Determines and collects cost-shares, and
partial payments for services to be received. Enter/verify payments
in the computer, close cash drawers, count currency, checks, and
credit card payments at the end of each shift, and create deposits
per cash handling policies. Provides patient liability information
and collects the point of service cash from patients based on
guidelines and/or systems provided by the department, including but
not limited to: co-payments, deductibles, co-insurance, deposits,
outstanding balances. Communicate to the patient the Northwest's
policy on payment of services or prepayment when significant
patient liabilities are identified. Refers, as appropriate, to
financial counselors. Interacts with Patient Business
Services/Membership Services personnel regarding status of accounts
as necessary to respond to questions/concerns related to
registration requirements. Documents all activity pertaining to
patient's account in the system.
- Appointing: May schedule and/or cancel right type of
appointment based on member's needs and regional protocol. If
applicable, makes return appointments.
- Regulatory/Organizational Compliance: Completes regulatory or
policy required forms, to include payor requirements such as
Medicare, L & I requirements and some commercial payors, and
obtains all necessary signatures via mail, pre-admit, pre-op visit
or upon admission/ registration. Makes copies of patient
identification, insurance information and other related forms and
documents, electronically scan capture where appropriate.
Understands and adheres to the rules and regulations of Medicare,
Medicaid, Managed Care and Commercial payers regarding referrals,
preauthorization and pre-certification requirements. Is
knowledgeable and maintains compliance with CMS by accurately
completing Medicare Secondary Payer screening information to
determine primary payor. Receives physician orders and, if
applicable, performs medical necessity check using automated
system. Interprets basic healthcare system's regulations and
policies for patients and patient families consistent with the
defined scope of work. Knowledge of MOAB training requirements for
managing aggressive behavior. Maintains an understanding of HIPAA
privacy and security regulations with respect to Patient
confidentiality and regulations that govern system use for patient
registration requirements. Understands and adheres to EMTALA
regulations and the relevance for patient registration and patient
liability collection in the Emergency Department.
- General Services: Stocks appropriate forms and supplies; takes
out used supplies. Demonstrating responsibility in handling
supplies and equipment in a cost-effective manner and according to
standards such as policies, procedures, and infection control
guidelines. Assist patients by providing specialty phone numbers,
facility directions and office layouts; directing to other
departments and administrative services for further information,
for example (but not limited to) Membership Services, Dental and
Pharmacy. Escorting patients to area of service. Initiates
safekeeping and return of Patients' valuables in accordance to
hospital policy when required. Provides information assistance to
Patients, visitors, and the public regarding general hospital
policies and procedures. Interacts with patient's physician
regarding status of hospital account/registration issues and refers
as needed. Provides patients' demographic information/insurance
plan updates to physician offices or other medical services, such
as EMT services where appropriate. Responsible for maintaining
records during system downtime and performs recovery processes.
Maintains accurate statistical records of departmental activities
as needed, for data gathering within the UBT work teams. Performs
all other duties as assigned consistent with job description.
- Minimum one (1) year of healthcare financial AND minimum one
(1) year of office environment customer service OR Minimum two (2)
years of post high school related education OR combination of
education and experience.
- High School Diploma or General Education Development (GED)
License, Certification, Registration
- Basic Life Support (BLS) for Health Care Providers required
- Basic Medical Terminology certificate.
- Must obtain training and Medical Terminology certificate within
180 days if existing Patient Access Employee or has proof of
completed Medical Terminology course, outside applicant must have
- Obtains training and becomes CPR Certification within 30 days
if existing Patient Access Employee or has proof of current CPR
Certification, outside applicant must have upon hire. Excellent
communication skills with all types of individuals.
- Excellent organizational and written skills, flexibility and
ability to switch tasks frequently.
- Ability to type minimum 35 wpm with above average
- Previous experience with cash handling required.
- Ability to operate CRT, IBM compatible PC, Windows, such as MS
Word/Excel, copier, fax, phone, and headset.
- Job requires continuous reading skills and the ability to
handle a heavy volume of work.
- Working knowledge of basic medical terminology, diagnostic
related groupings, diagnosis and common procedure terminology to
determine benefits and estimate service cost.
- Knowledge of Medicaid, Medicare, and other government and
- Knowledge of basic State and Federal regulations governing
healthcare encounters, such as HIPAA, State worker's compensation,
third party liability for accidents, EMTALA and etc.
- Knowledge of and skill in the use of automated Patient care
systems for admissions, registration, and basic medical records
functions (registration systems).
- Knowledge of basic state and federal regulations regarding
- Knowledge of organization's and/or facility based billing
- Knowledge of department procedures and established
- Knowledge of communication techniques with ability to listen
actively and respond to fellow employees/customers in a timely,
competent manner both verbally and non-verbally.
- Obtains training to become a Certified Healthcare Access
Associate by the National Association of Healthcare Access
Management within 180 days of employment preferred.
- Previous experience with EPIC applications preferred.
- Previous hospital or ambulatory clinic registration
- Certification by HFMA or NAHAM preferred.
- One (1) year of higher education preferred.
Keywords: Kaiser Permanente Zion Medical Center, Hillsboro , Patient Access Representative I 12 HR-KSMC, Other , Hillsboro, Oregon
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