This position is responsible for completing
the financial clearance process within Patient Access Services
(PAS) and creating the first impression of WTH’s services to
patients and families and other external customers. The PAS
Representative must be able to articulate information in a manner
that patients, guarantors, and family members understand so they
know what to expect and have an understanding of their financial
responsibilities. This position assumes responsibility for
collecting and documenting information on behalf of the patient.
Responsible for obtaining, coordinating, and directing information
from patients, physician offices, hospital departments, and clinics
in order to schedule patient appointments. The PAS Representative
may be responsible for completing the pre-registration,
registration, insurance verification, benefits verification,
certification, referral management, patient liability collections,
and medical necessity check -- as well as interviewing patients and
guarantors to obtain information to screen for financial
counseling, verifying eligibility and corresponding benefit levels,
coordinating referrals, and obtaining treatment authorizations. PAS
reps may also be responsible for scheduling patients. The PAS
representative will also work with medical staff, nursing,
ancillary departments, insurance payers, and other external sources
to assist families in obtaining healthcare and financial services.
The employee is subject to call back and overtime as required by
Process - Maintains the best practice
routine per department guidelines. Daily work queues are maintained
at acceptable levels according to department policies.
Correspondence worked daily to current.
Registration - Performs financial clearance process by interviewing
patients and collecting and recording all necessary information for
pre-registration and registration of patients. Ensures that proper
insurance payer plan choice and billing address are assigned in the
automated patient accounting system. Verifies relevant group/ID
Completes the registration process according to established
policies and procedures.
Ensures patient receives necessary disclosures, privacy
information, and signs the relevant documentation.
Financial Clearance - Contacts payers to verify insurance
eligibility. Completes automated insurance eligibility
verification, when applicable, and appropriately documents
information in the patient accounting system. Determines the
patient’s insurance type and educates patients regarding coverage
and/or coverage issues.
Informs families with inadequate insurance coverage regarding
financial assistance through government and financial assistance
programs. Performs initial financial screening and refers accounts
for financial counseling and/or appropriate eligibility
Ensures all referrals and treatment authorizations for all patient
types have been obtained according to the outlined requirements. If
not obtained, contact payers for approvals.
8. Completes initial medical necessity checks. Refers to the
designated area if medical necessity fails or if referrals
authorizations are denied.
Responsible for obtaining complete and accurate demographic,
financial, and clinical information to help ensure maximum
reimbursement for the hospital.
Pre-Service / Point of Service Collection - Interprets third-party
payer policies to establish patient financial liabilities and work
with patients so they understand their patient financial
Collect co-payments, co-insurance, and deductibles according to
pre-service/ point of service collections policies and
Communication & Miscellaneous - Advises next-level leader of
possible postponement or deferrals of any elective/non-emergent
admission which has not been approved prior to service date.
Maintains accurate files for pre-processing information as
Investigates, resolves, and documents patient problems in a timely
and efficient manner. Maintains accurate files for pre-processing
Investigates, resolves, and documents patient problems and contact
medical staff, nursing staff, ancillary departments, and
administration as necessary.
Assists with cross-training function in areas within Patient Access
Performs related responsibilities as required or directed.
High School Graduate, or equivalent.
1-2 years of health care or related experience preferred.