Patient Access Representative - PAR - Plastics and Reconstructive Surgery

Patient Access Representative - PAR - Plastics and Reconstructive Surgery
Heritage Healthcare
Requisition # R273238
Job Summary: The role of the Patient Access Representative is to facilitate the process that enables collection of payment for services rendered. Primary responsibilities will be to obtain all referrals and authorizations necessary to perform related services.
Essential Values-Based, Leadership and Management Competencies: Demonstrates values-based competencies in line with the four core values that are the foundation of all activities performed by employees in order to achieve the Mission of the St. Joseph Health System.
Dignity: Demonstrates competence in communication and interpersonal relations.
Excellence: Demonstrates competence in continuous improvement, continuous learning, accountability, and teamwork.
Service: Demonstrates competence in customer/patient focus and adaptability.
Justice: Demonstrates competence in community orientation and stewardship.
Essential Functions:
? Receives new patient information registration forms and enters information into the PRISM system.
? If appropriate, informs check-in of any patient responsible payments to be collected at time of appointment.
? Greets/interviews new patients and discusses co-payments, prior authorization requirements.
? Reviews upcoming schedules by patient account and checks to see that current referral/authorization is in place. If not, current call or FAX request to primary care physician or, calls appropriate insurance company?s Utilization Review Department.
? Verifies current eligibility for Medi-Cal patients via AEVS. Obtains treatment Authorization Requests for Medi-Cal patients, as required
? Enters all new referral/authorization and Prism, as appropriate, and Medi-Cal confirmations into PRISM system.
? Reviews updated schedule for next day and at end of day. Rechecks schedule for any "add-ons" to review for treatment authorization.
? Obtains prior authorizations for certain outside services (such as MRI's, CT's, and scans), scheduled hospital admits, etc. (some by phone, some paper). Furnishes ancillary providers with appropriate authorization.
? Obtains continuous authorizations for HMO patients for on-going specialty care.
? Follows up on authorization requests that are pending.
? Enters approvals in PRISM and distributes to appropriate department
? Receives new insurance information on existing patients and enters into PRISM System
? Assists patients with questions and/or problems regarding insurance referrals, authorizations
? Creates insurance information form on each new patient for chart and updates form when insurance changes
? Maintains authorization and referral files and documents in an orderly manner.
? Works closely with Patient Financial Counselor to update information regarding patient authorizations and referrals.
? Maintains and updates Provider Manuals of contracted carriers.
? Keeps abreast of changes in various insurance provisions and requirements via bulletins, updates, seminars, meetings, and other resources.
? Back up and work in other areas of the front office as needed.
Additional Responsibilities:
? Uses professionalism and honesty in all business dealings on behalf of SJHH.
? Adheres to all attendance policies at SJHH.
? Remains flexible with regards to job assignments that may require the necessity to cover other departments or locations.
? Demonstrates excellence in customer service when dealing with both external and internal persons while on the job.
? Adheres to all policies and procedures set forth at SJHH and all applicable laws under which SJHH is obligated to comply.
? Performs other duties as assigned.
Age-Related Competencies: Demonstrates age appropriate communication skills for the population served.
Information Management: Treats all information and data within the scope of the position with complete confidentiality and security. Maintains all practices to protect PHI and follow HIPAA guidelines.
Risk Management: Cooperates fully in all risk management activities and investigations.
Safety Requirements: Is knowledgeable of, observes and complies with hospital Codes of Safe Practice, safety policies and emergency procedures.
Minimum Position Qualifications:
Education: High School graduate or GED required.
? One (1) plus year?s related experience and/or training required.
? Experience with insurance contracts, referrals, authorizations, and public relations skills is required.
Computer Skills: Basic computer skills including Windows operating environment, Microsoft Word, and an e-mail system.
Knowledge / Skills / Abilities:
? Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
? Ability to write reports, business correspondence, and procedure manuals.
? Ability to effectively present information and respond to questions from groups of managers, patients, physicians, and outside Prismal personnel.
? Ability to add, subtract multiply, and divide all units of measure, using whole numbers, common fractions, and decimals.
? Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
? Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Environmental Conditions: The noise level in the work environment is usually quiet. Minimal risk of exposure to health hazards when in patient care areas of clinics, or interacting with those doing direct patient care.
Physical Requirements: While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, feel, and use keyboard. Specific vision abilities required by this job include close vision, and ability to adjust focus.
St. Joseph Heritage Healthcare (SJHH) is one of California's most respected medical groups. With over 3,000 employees and 75 locations throughout California, including, Northern California, Orange County, High Desert and Los Angeles County, SJHH has been continually recognized as a leader in quality, customer service and information technology. This kind of success is the result of team work, a commitment to excellence and a strong adherence to the organization's mission, vision and values.
St. Joseph Heritage Healthcare (SJHH) provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, St. Joseph Heritage Healthcare (SJHH) complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Don't Be Fooled

The fraudster will send a check to the victim who has accepted a job. The check can be for multiple reasons such as signing bonus, supplies, etc. The victim will be instructed to deposit the check and use the money for any of these reasons and then instructed to send the remaining funds to the fraudster. The check will bounce and the victim is left responsible.