Under general supervision, coordinates and performs multiple complex functions within the Patient Access department. Utilizes judgment to interpret department policies to resolve routine to complex inquiries/patient account problems with other departments. Identifies opportunities for process improvements and offers potential solutions. Participates in meetings as a representative of the department. Serves as a resource to team members for training, problem resolution, etc. Performs all duties in a manner that promotes a team concept and reflects the mission, behaviors, core values and philosophy of CT Children’s Medical Center. Administrative: • Following department protocol provides general receptionist, secretarial support, or Health Unit Coordinator functions. • Performs a variety of administrative support activities in support of the unit operations. • Responds with tact and discretion to the needs of patients and families. • Maintains privacy and confidentiality. • Assists with staffing assignments and scheduling as requested. Registration: • Collects and enters accurate demographic, guarantor and financial data for Emergency Department, Inpatient and Outpatient cases and Physician Practice Office appointments. • Verifies all required insurance and billing information and uses the proper payer plan codes. • Generates all necessary forms for patient visit and obtains patient/parent/legal guardian signature for Assignment/ Authorization and consent. • Performs pre-registration for scheduled patients and registers patients upon arrival adhering to standard department procedure. • Makes corrections and updates patient information in computer systems as necessary. • Asks patients/families whether their visit was satisfactory and attempts to address any questions/issues prior to patient departure. • Documents thorough, clear, explanatory notes regarding reasons for incomplete information at time of registration. Documents concise and understandable comments regarding patient or guarantor interaction, efforts to collect co-payments and referrals to Financial Assistance. • Follows-up on open items to resolve outstanding issues and complete the file. • Reviews all documentation records regarding incomplete information at time of registration, patient or guarantor interaction, efforts to collect co-payments, estimated self-pay balances and referrals to Financial Assistance. • Follows up with team member responsible for resolving the open issue to provide assistance or additional training to ensure prompt completion of the file. • Reviews and works assigned work queues for registration information to ensure that accounts are accurate at time of visit and or billing. Scheduling: • Schedule complex appointments either in person or via telephone • Creates/inputs complex department provider appointments. • May schedule/coordinate appointments with other areas of the hospital. • As a first line representative of CT Children’s, this person must have the ability to deal compassionately and professionally with patients and families. Front Office (Check-In): • Arrives patients for their appointment in the ADT system. • Verifies demographic and insurance information at time of arrival (including securing patient financial liability at time of service). • Check out process including scheduling or rescheduling future appointments. • Answer telephone and triage calls for the department. • Ensure all consent and privacy forms are signed. • Work directly with DCF to obtain appropriate signatures/legal guardian information. • Enters routine to complex patient charges into billing system for physician or care provider visits, according to protocol. • Other front office duties as required. Financial Clearance: • Responsible for various work queues of scheduled and/or non-scheduled appointments. • Communicates with insurance companies to obtain benefits, referrals, and/or authorization requirements. • Communicates with Clinical/Office staff of patient eligibility, authorization status, and need for clinical documentation. • Completes chart reviews to submit all appropriate documentation to insurance companies for authorization purposes. • Coordinates with third party payers regarding information necessary for appropriate financial processing of patients, including: follow-ups with primary care providers for referrals and authorizations; notifying insurance carriers of admissions; obtaining authorizations and verifying benefits eligibility. • Refers patients/families to Financial Counseling for updated and/or eligibility issues. • Works directly with RN, APRN, and MD level staff to notify of denials requiring further action. • Coordinates with Utilization Review for status designation of Outpatient/Inpatient Admissions. Financial Counselor: • Interviews patients to verify complete insurance and financial information, explain financial policies, complete appropriate financial evaluation forms. • Refers patients/ families to DSS and Financial Assistance. • Determines guarantor’s propensity to pay non-covered charges, as well as determine potential eligibility for financial assistance programs. • Establishes financial arrangements / payment plans with patients. • Identifies reason(s) for non-payment and follows-up to ensure resolution. Financial Responsibility: • Verifies insurance plans using the various methods available such as RTE, Web-Based, & Telecommunications. • Investigates patient insurance coverage, facilitates certification, manages process to maximize payment from both commercial and managed care plans. • Follows-up with team member responsible for patient account to resolve outstanding financial issues. • Demonstrates knowledge of the age-related differences and needs of patients in appropriate, specific populations from neonate through adolescence and applies them to practice. • Demonstrates cultural sensitivity in all interactions with patients/families. Demonstrates support for the mission, values and goals of the organization through behaviors that are consistent with the CT Children’s STANDARDS Education and/or Experience Required: • High School Diploma, GED, or a higher level of education that would require the completion of high school, is required. • 5-7 years directly related experience preferred; Healthcare experience required. Education and/or Experience Preferred: • Associates Degree preferred. License and/or Certification: Required: None Preferred: CHAA (Certified Healthcare Access Associate). Knowledge, Skills and Abilities: Knowledge of: • Intermediate knowledge of MS Word and Excel. • ADT systems and Insurance Verification systems (EPIC preferred). • Knowledge of Managed Care, referral/pre-certification/ authorization process. • HIPAA. Skills: • Computer, typing, data entry. • Excellent telephone and communication skills. • Strong organizational skills. Ability to: • Handle a fast paced, high-volume environment, • Work in a team environment alongside multiple disciplines. • Provide guidance and assist in training to peers. • Have crucial conversations with others/ peers.