PAS Revenue Cycle Specialist

Job Description:

Department Overview

The purpose of this position is to greet and ¿arrive¿ patients presenting to the Emergency department, interview patients to obtain demographic, accident, and financial information in order to facilitate patient care and support front end billing activities. This position supports Oregon Health & Sciences University¿s mission by providing excellent customer service to every patient, patient families, visitors, and staff who present to any area of the Patient Access Services Department, either in person, via telephone, or over electronic communications.

Function/Duties of Position

CUSTOMER SERVICE:

• Provides high quality customer service to both external and internal customers that meets or exceeds the service standards of the health care industry. 
• Promptly greet all patients, visitors, and others in a warm, courteous, and professional manner, face to face or over the phone.   
• Demonstrates the ability to communicate effectively, timely, and respectfully at all times, especially in a high stress environment.
• Provides flexible coverage to assist with internal service needs and the continuous application of process improvement methods and skills.
• Determines customer needs proactively, and direct inquiries to appropriate resources.
• As problems and miscommunications occur with internal or external customers, demonstrates the ability to clarify and resolve problems immediately to avoid further communication breakdowns.
• Demonstrates respect and cooperation in all staff relationships, with a genuine willingness to prevent or resolve inter-personal conflicts.  
• Demonstrates knowledge of all department locations, units, and buildings on OHSU Campus.  
• Answers multi-line telephone inquiries.  Determine caller needs and assist callers efficiently and appropriately.
• Determine priorities and act quickly, make decisions efficiently and in a calm manner in emergency and stressful situations.  
• Facilitating incoming after hours foot traffic into OHSU hospital.  This includes providing directions and screening of all patients and visitors.
• Liaison between clinical team, social work and case management for complicated patients and family members.
• Utilizes appropriate interpreter services when necessary.
• Keep patients in lobby area updated.

PATIENT REGISTRATION:

• Perform established patient search methods for medical record number in computer database.
• Properly identify and arrive patients that arrive in the ED whether it is a walk in or by ambulance.
• Gathers, adds, updates, and/or verifies detailed demographic information and completed/signed forms required for services. These functions are performed at stationary computer terminals or at patient’s bedside using a mobile computer terminal, occasionally over the phone.  Hand written documentation may only be utilized during computer downtime or device malfunction. 
• Completes Race, Ethnicity, Language, and Disability (REALD) questionnaire with patient face to face or over the phone and updates REALD Smart Form as required by law. Serves as liaison for patients and families with questions.
• Satisfies state regulations to identify support persons for individuals with disabilities.
• Identifies unidentified patients and marks old account for merge, if necessary. 
• Corrects patient identity inaccuracies, as identified.
• Accurately complete Inter-Hospital Transfers and same-day admissions and obtain prior medical records as needed.
• Activates direct admissions based on notification from unit at time of patient’s arrival. 
• Follows Oregon Administrative Rules (OAR’s) regarding workers’ compensation in operation of OHSU and industry workman’s compensation procedures.  Provides timely follow up for completion of workman’s compensation “827” and DOLI form for work related injuries.
• Initiates and completes claims for worker’s compensation injuries, personal injury, motor vehicle accidents, and crime victim accounts.
• Provides patient education regarding OHSU financial assistance, insurance coordination of benefits, Patient Rights, Terms & Conditions, Advance Directives, Medicare Secondary Payer Questionnaire, Important Message from Medicare, Medicare Outpatient Observation Notice, Champus Message to patients and their representatives, Notice of Privacy Practices, use of patient information and/or specimens in OHSU research, and other facility or regulatory documents. 
• Obtains signatures and enters into computer all facility and regulatory required data and forms.  Reviews all for accuracy. 
• Identifies and collect co-pays/deposits as required. 
• Provides receipts and completes necessary accounting procedures including reconciliation and deposit of funds.
• Creates and assembles Patient Packets as required for Hospital @ Home patients.
• Determines urgent/emergent medical situations and activates rapid response team or engages the assistance of nursing staff to assist.
• Manage patient valuables process.
• Required to maintain Patient Access Services Individual Performance Standards which includes:
• Production Standard: Meets individual standard determined by shift of PAS work activities/completed registrations per day.
• Error Rate Standard: Maintain an accuracy rate of 97%.
• Customer Service:  2 or fewer validated customer service complaints in any rolling one year period. Must follow the OHSU Model of Communication in 100% of customer interactions and consistently demonstrate exemplary internal and external customer contact skills. 

INSURANCE VERIFICATION/FINANCIAL CLEARANCE:

• Gathers, adds, updates, and/or verifies detailed insurance coverage and financial status with each patient over the phone or face to face.  
• Creates new and maintains existing insurance coverages/guarantors for a patient based on their insurances and the care being provided.
• Obtains benefit information including deductible or co-pays, co-insurance, stoploss or out of pocket status, and correct billing address.   
• Complete insurance verification on each patient’s insurance 100% of the time when the insurance verification status says New, Elapsed, Incomplete, Needs Review, or is Medicaid, using electronic verification in RTE, payer portals, or other required methods.  The PAS Revenue Cycle Specialist staff will also re-verify the eligibility insurance information if the insurance was not verified in the current month.  
• Reviews MMIS for all uninsured or single coverage patients 
• Refers all non-sponsored patients to Oregon Health Plan (OHP) and provides information for financial assistance, working closely with Financial and Medicaid Services.
• Ensures all required forms are completed for services and confirmation of payment sources. 
• As required, notifies payors of admissions to OHSU Facilities for patients that are treated in the Emergency Department, facility-to-facility transfers for higher level of care, or direct admissions. 
• Maintains current information on managed care insurance plans and serves as a liaison and information resource for patients, referring physician offices, and other OHSU staff.  Applies problem solving and negotiating skills in resolving patient concerns and managed care related issues.
• Maintain knowledge pertaining to insurance issues which include but are not limited to motor vehicle, Worker’s Compensation, personal injuries, Medicare, OHP/Washington Welfare/Medicaid, and exposures.
• Collects detailed information of trauma admissions (motor vehicle accident, personal injury, and/or worker’s compensation) to determine accident-related liability. 
• Maintain access to all insurance website by signing in one time per month, at minimum. 

TRAINING, COMPETENCY, AND OPERATIONS:

• Sustains working knowledge of PAS Specialist and PAS Revenue Cycle Specialist workflows for applicable areas.
• Successfully complete the required PAS Specialist and PAS Revenue Cycle Specialist initial training and core competency assessment during the initial probationary period.  Required to complete ADT/Grand Central training sequence.  Depending on role, may also be required to complete Insurance Identification & Eligibility Training.  
• Completes all required update modules. Maintains core competencies, and demonstrates continuous application of these skills throughout the period of employment.
• Gives instruction to other PAS Revenue Cycle Specialist personnel pertaining to PAS Revenue Cycle Specialist processes and procedures as well as performance.  Provides on the job training, orientation, guidance and coaching for new PAS Revenue Cycle Specialist personnel in the service area as assigned.  May be required to provide informational assessment of other PAS Revenue Cycle Specialist workers’ performance to the PAS Coordinator/Supervisor and/or the employment supervisor.

OTHER DUTIES AS ASSIGNED-INCLUDING; BUT NOT LIMITED TO:

• Schedule reservations into the computer system with a base knowledge of diagnoses and procedures.
• Troubleshoots equipment problems and initiates repairs requests once reviewed with leadership.
• Accommodates patient special needs, including obtaining equipment for mobility issues.
• Coordinates Epic downtime recovery functions during scheduled and unscheduled downtimes.
• Ensures Patient Access Services Department Coordinator is aware of low forms/supply levels.
• Demonstrates effective use of resources. 

COMPLIANCE:

• Carry out job responsibilities in an ethical, effective, and professional manner. 
• Model ethical and appropriate behavior, professional standards, compliance, and personal integrity. 
• Report potential compliance problems using the reporting processes as outlined in the Code of Conduct. 
• Understand and comply with the Code of Conduct, OHSU and departmental Policies and Procedures, applicable rules and regulations. 
• Attendance:  Adherence to hospital and departmental policies regarding attendance.
• Dress Code:  Consistently projects a positive and professional image through appearance, behavior, and adherence to the OHSU Hospital and Clinics Dress Code.