Kaiser Permanente Northwest
Representative, Patient Access I-KSMC
Kaiser Permanente Northwest, Hillsboro, Oregon, United States, 97104
Job Summary
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 and 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, completing documentation necessary for the expedient registration and admission of patients according to organizational policy, procedures, and federal, state, and regulatory requirements.
Obtaining inpatient bed assignments, processing inpatient admission (including direct admit), following patient identification protocols, and completing necessary documentation. Referring patients to Financial Counselors for medical financial assistance. Answering and/or referring questions received from patients, visitors, and staff as appropriate. Performing related cash handling procedures per SOX control regulations. This position acts as an ambassador to ensure a patient-friendly experience. The role requires knowledge of state and federal regulations governing patient healthcare encounters to assure compliance.
Essential Responsibilities
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 to obtain demographic information, insurance data, and third‑party liability information. Performs minimal eligibility verification and resolves discrepancies, refers to the Financial Counselor as necessary. Verifies patient demographic and insurance information with the patient consistent with CMS regulations and regional policies. Verifies member eligibility and benefits from identified insurance plans prior to or upon admission, using computer‑based verification programs. Uses problem‑solving skills to verify patient identification to minimize duplicate medical records. 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. Enters and verifies payments in the computer, closes cash drawers, counts currency, checks, and credit card payments at the end of each shift, and creates deposits per cash handling policies. Provides patient liability information and collects point‑of‑service cash based on guidelines. Refers to financial counselors. Interacts with Patient Business Services/Membership Services personnel regarding account status. Documents all activity pertaining to patient accounts in the system.
Appointing:
May schedule and/or cancel appointments based on member needs and regional protocol. Makes return appointments as applicable.
Regulatory/Organizational Compliance:
Completes regulatory or policy‑required forms, including payor requirements such as Medicare, L & I, and some commercial payors, and obtains necessary signatures. Makes copies of patient identification, insurance information, and related forms; captures electronically where appropriate. Adheres to Medicare, Medicaid, Managed Care, and commercial payer rules regarding referrals, preauthorization, and pre‑certification. Maintains compliance with CMS by accurately completing Medicare Secondary Payer screening. Receives physician orders and performs medical necessity checks using automated systems. Maintains knowledge of HIPAA privacy and security regulations and EMTALA regulations.
General Services:
Stocks appropriate forms and supplies; takes out used supplies. Demonstrates responsibility in handling supplies in a cost‑effective manner. Assists patients with specialty phone numbers, facility directions, and office layouts; directs to other departments and administrative services. Escorts patients to appropriate areas. Initiates safekeeping and return of patient valuables in accordance with hospital policy. Provides general policy and procedure information. Maintains records during system downtime, performs recovery processes, and maintains statistical records of departmental activities. Performs all other duties as assigned.
Experience
Basic Qualifications: 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.
Per the National Agreement, current KP Coalition employees have this experience requirement waived.
Education: High School Diploma or General Education Development (GED) required.
License, Certification, Registration: Medical Terminology Certification
Basic Life Support
Additional Requirements
Must obtain Medical Terminology certification within 180 days if existing Patient Access Employee or provide proof of completion; outside applicant must obtain upon hire.
Must obtain CPR certification within 30 days if existing Patient Access Employee or provide proof; outside applicant must obtain 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 words per minute with above average accuracy.
Previous experience with cash handling required.
Ability to operate CRT, IBM compatible PC, Windows, MS Word/Excel, copier, fax, phone, and headset.
Job requires continuous reading skills and ability to handle a heavy volume of work.
Working knowledge of basic medical terminology, diagnostic‑related groupings, diagnoses and common procedure terminology to determine benefits and estimate service cost.
Knowledge of Medicaid, Medicare, and other government and insurance/payor requirements.
Knowledge of basic state and federal regulations governing healthcare encounters (HIPAA, State workers’ compensation, third‑party liability for accidents, EMTALA, etc.).
Knowledge of automated patient care systems for admissions, registration, and basic medical records functions.
Knowledge of basic state and federal funding regulations.
Knowledge of organizational and facility billing systems.
Knowledge of confidentiality policies and communication techniques.
Preferred Qualifications
Previous experience with EPIC applications preferred.
Previous hospital or ambulatory clinic registration experience.
Certification by HFMA or NAHAM preferred.
Obtains training to become a Certified Healthcare Access Associate within 180 days of employment preferred.
One (1) year of higher education preferred.
Seniority Level
Entry level
Employment Type
Full-time
Job Function
Health Care Provider
Industries
Hospitals and Health Care
#J-18808-Ljbffr
Obtaining inpatient bed assignments, processing inpatient admission (including direct admit), following patient identification protocols, and completing necessary documentation. Referring patients to Financial Counselors for medical financial assistance. Answering and/or referring questions received from patients, visitors, and staff as appropriate. Performing related cash handling procedures per SOX control regulations. This position acts as an ambassador to ensure a patient-friendly experience. The role requires knowledge of state and federal regulations governing patient healthcare encounters to assure compliance.
Essential Responsibilities
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 to obtain demographic information, insurance data, and third‑party liability information. Performs minimal eligibility verification and resolves discrepancies, refers to the Financial Counselor as necessary. Verifies patient demographic and insurance information with the patient consistent with CMS regulations and regional policies. Verifies member eligibility and benefits from identified insurance plans prior to or upon admission, using computer‑based verification programs. Uses problem‑solving skills to verify patient identification to minimize duplicate medical records. 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. Enters and verifies payments in the computer, closes cash drawers, counts currency, checks, and credit card payments at the end of each shift, and creates deposits per cash handling policies. Provides patient liability information and collects point‑of‑service cash based on guidelines. Refers to financial counselors. Interacts with Patient Business Services/Membership Services personnel regarding account status. Documents all activity pertaining to patient accounts in the system.
Appointing:
May schedule and/or cancel appointments based on member needs and regional protocol. Makes return appointments as applicable.
Regulatory/Organizational Compliance:
Completes regulatory or policy‑required forms, including payor requirements such as Medicare, L & I, and some commercial payors, and obtains necessary signatures. Makes copies of patient identification, insurance information, and related forms; captures electronically where appropriate. Adheres to Medicare, Medicaid, Managed Care, and commercial payer rules regarding referrals, preauthorization, and pre‑certification. Maintains compliance with CMS by accurately completing Medicare Secondary Payer screening. Receives physician orders and performs medical necessity checks using automated systems. Maintains knowledge of HIPAA privacy and security regulations and EMTALA regulations.
General Services:
Stocks appropriate forms and supplies; takes out used supplies. Demonstrates responsibility in handling supplies in a cost‑effective manner. Assists patients with specialty phone numbers, facility directions, and office layouts; directs to other departments and administrative services. Escorts patients to appropriate areas. Initiates safekeeping and return of patient valuables in accordance with hospital policy. Provides general policy and procedure information. Maintains records during system downtime, performs recovery processes, and maintains statistical records of departmental activities. Performs all other duties as assigned.
Experience
Basic Qualifications: 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.
Per the National Agreement, current KP Coalition employees have this experience requirement waived.
Education: High School Diploma or General Education Development (GED) required.
License, Certification, Registration: Medical Terminology Certification
Basic Life Support
Additional Requirements
Must obtain Medical Terminology certification within 180 days if existing Patient Access Employee or provide proof of completion; outside applicant must obtain upon hire.
Must obtain CPR certification within 30 days if existing Patient Access Employee or provide proof; outside applicant must obtain 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 words per minute with above average accuracy.
Previous experience with cash handling required.
Ability to operate CRT, IBM compatible PC, Windows, MS Word/Excel, copier, fax, phone, and headset.
Job requires continuous reading skills and ability to handle a heavy volume of work.
Working knowledge of basic medical terminology, diagnostic‑related groupings, diagnoses and common procedure terminology to determine benefits and estimate service cost.
Knowledge of Medicaid, Medicare, and other government and insurance/payor requirements.
Knowledge of basic state and federal regulations governing healthcare encounters (HIPAA, State workers’ compensation, third‑party liability for accidents, EMTALA, etc.).
Knowledge of automated patient care systems for admissions, registration, and basic medical records functions.
Knowledge of basic state and federal funding regulations.
Knowledge of organizational and facility billing systems.
Knowledge of confidentiality policies and communication techniques.
Preferred Qualifications
Previous experience with EPIC applications preferred.
Previous hospital or ambulatory clinic registration experience.
Certification by HFMA or NAHAM preferred.
Obtains training to become a Certified Healthcare Access Associate within 180 days of employment preferred.
One (1) year of higher education preferred.
Seniority Level
Entry level
Employment Type
Full-time
Job Function
Health Care Provider
Industries
Hospitals and Health Care
#J-18808-Ljbffr