Facility:Dayton Children's - Tech TownDepartment:Patient Access - SchedulingSchedule:Full timeHours:40Job Details:Patient Access Representatives provide customer-service coverage and assume the responsibility for successful financial outcomes of all patient services. Under the general supervision of the Patient Access Manager, this position performs imperative duties, which may include, but not limited to appointment scheduling, registration, transcribing orders, insurance verification, telephone coverage, data entry, filing protected health information (PHI), patient referrals, and payment collection, while maintaining patient relations, customer satisfaction, and Dayton Children’s Hospital financial solvency.

Department Specific Job Details:

Job Duties and Responsibilities

Weighting %

Primary Duties and Responsibilities

• Promptly fields and/or directs incoming calls and responds to patient and/or staff inquiries when necessary

• Transcribe incoming orders to medical record via multiple electronic inputs

• Researches provider templates to match visit type to appropriate scheduling block

• Makes outbound calls to reach patients that cancel or no-show to reschedule

• Manages competing priorities of inbound and outbound calls simultaneously

• Responsible to review individual and team performance metrics and create plan of action for improvement

• Coordinates appointment times with clinical staff for multiple visits same-day

• Documents and verifies all appropriate, confidential health and financial information from patient/guarantor/subscriber while using various computer software to assure payment for all authorized services.

• Obtains legal consent for treatment at the time of registration

• Verifies insurance eligibility and benefits within a timeframe determined by Dayton Children’s Hospital

• Verifies medical necessity in accordance with Centers for Medicare & Medicaid Services (CMS) standards and communicates relevant coverage/eligibility information to the patient

• Identifies patients who will need Medicare Advance Beneficiary Notices (ABNs) of non-coverage and maintains accurate records of authorizations within the [EHR]

• Collects out-of-pocket liabilities from patients upfront and applies, adjusts, and reconciles daily cash reports according to all organizational, state, and federal laws and regulations

• Refers patient accounts to financial advocates when further explanation/education is needed regarding denied authorizations, out-of-pocket liabilities, coverage options, payment plans, etc.

• Exhibits professionalism in appearance, hygiene, speech and conduct in accordance with organizational standards

70%

2. Quality Improvement and Compliance

• Demonstrate awareness of department goals

• Offer ideas and suggestions to make processes more efficient

• Participate in the development of department goals and quality improvement indicators.

• Keep the supervisor informed of any problems or concerns

10%

3. Additional Responsibilities

• Demonstrates proficient customer-service skills by greeting and treating all patients and staff with respect, discretion and dignity using AIDET standards

• Complies with all organizational, state, and federal laws and regulations related to patient privacy and confidentiality, such as the Health Insurance Portability and Accountability Act (HIPAA)

  • Demonstrates understanding of insurance protocols for referrals, co-payments, deductibles, allowances, etc., and analyzes information received to determine patients’ out-of-pocket liabilities

10%

4. Education

• Participates in continuing education as needed to maintain current knowledge of role, revenue cycle and industry standards

• Stays informed of state and federal regulations in relation to hospital reimbursement, and maintains communication with personnel in HIM departments and the business office to ensure accurate reimbursement

• Stays current with all policies and mandatory education. Collaborates with patient access quality compliance coordinators, when in need of quality improvement measures, to improve overall revenue cycle accuracy

5%

5. Performs other duties as assigned

   5%

100%

Additional Criteria for Tier II

• Must maintain a position on Dayton Children’s Scheduling or Registration team for at least one year

• Must not be on any type of corrective action or performance improvement plan within the last year

• Competent to perform cost estimates for lab, imaging and surgery, OR competent to schedule on 2 or more teams in central scheduling department,

• Successful completion of patient access curriculum and certification must be current

• Active in training and mentoring new staff

• Must have successfully completed a live education class, if available, assigned by your Supervisor.

Additional Criteria for Tier III

• Two years of experience in patient access department or related healthcare facility

• Competent to perform pre-authorization for medication, imaging, and outpatient procedure, testing or surgical services, OR, competent to perform registration function for all covered access departments, i.e., urgent care, emergency services, clinics, and lab/imaging, as well as scheduling function, OR competent to schedule for at least 2 or more outpatient clinics.

• Consistently supports training of new employees

• Identifies process improvement opportunities

• Supports special projects

• Maintains prior-authorization or scheduling specific certification

Education Requirements:

GED, High School (Required)

Certification/License Requirements:

At Dayton Children's we believe that each moment counts with our patients, families and with each other.

We are moving at a fast pace and are looking for the right talent for our team at Dayton Children's. We want people who embody our values and want to become a part of the Dayton Children's difference. If this is you, apply today!

Our values:

• Safety--We make safety our first priority.

• Compassion--We deliver compassionate, family-centered care to all we serve.

• Ownership--We are the pediatric care experts and act knowing that every patient, visitor and the hospital is our collective responsibility.

• Collaboration--We work collaboratively to care for children, their families and each other.

• Innovation--We continuously innovate to make Dayton Children's even better today and into the future.

• Equity -- We strive for an environment in which all feel welcomed, valued and fairly treated in order to reach their full potential.

Dayton Children’s is proud to be an Equal Opportunity Employer who values diversity and will not discriminate against minorities, women, protected veterans, individuals with disabilities, or on the basis of age, color, gender identity, national origin, race, religion, sex, sexual orientation or transgender status.