The Patient Access Representative II (PAR II) is a unique role w/in the KP Health System environment. The position welcomes the patient into the care delivery setting & initiates the administrative systems that will lay the groundwork for the patient's clinical care as well as the financial documentation. Is responsible for ensuring a complete & accurate patient admission/registration. This position is an intermediate level position that requires a professional service-oriented individual w/ strong organizational skills working under limited supervision. This position acts as an ambassador to ensure a patient friendly experience. The PAR II has knowledge of state & federal regulations governing patient healthcare encounters & assures compliance.

　　Essential Functions:

　　Greets & registers patients for various medical services in the hospital setting potentially in a 24 hour, 7 day a week environment & in a highly active fast paced setting such as the Emergency dept

　　Completes comprehensive bedside or telephone interviews w/ Patient, relative, or their representative to obtain pertinent demographic information, insurance data and/or third party liability information

　　Performs complex eligibility verification & resolves any discrepancies, identifies need for financial assistance recommendation & application, referring to the Financial Counselor where necessary

　　Verifies the patient demographic & insurance information w/ the patient consistent w/ CMS regulations, the National Registration Standards & regional policies

　　Verifies Insurance Eligibility & Benefits (include policy limitations) for all payers prior to or upon admission to the hospital, using computer based verification programs, as available

　　For Medicare, using approved system to determine eligibility, co-insurance days, lifetime reserve days etc& notify Utilization Mgmt when a patient will be utilizing his/her lifetime reserve days

　　For other governmental payers such as Medicaid, use the state's approved system to check for eligibility & benefit information

　　Uses problem-solving skills to verify patient identification through patient name, spouse names, SSN, DOB & address in order to identify & minimize duplicate medical records

　　Interview patient to obtain/determine appropriate insurance carrier & identifies, verifies, & inputs Other Coverage Information (OCI), primary, secondary, & tertiary payers for services provided

　　Completes registration requirements for professional billing into HealthConnect for patients receiving services at northwest plan hospitals

　　Performs registration function for all patient class & clinical services

　　Completes admission protocol for allied hospitals

　　Maintains recurring/series patient files & preforms co-preadmission functions

　　Maintains & completes pre-admission processes for surgical admission in preparation for date of service

　　Determines & collects cost-shares, & partial payments for services to be received

　　Provides patient liability information & collects the point of service cash from patients based on guidelines and/or systems provided by the dept

　　May schedule and/or cancel right type of appointment based on member's needs & regional protocol

　　Completes regulatory or policy required forms & obtains all necessary signatures via mail, pre-admit, pre-op visit or upon admission/ registration

　　Fully understands & adheres to the rules & regulations of Medicare, Medicaid, Managed Care & Commercial payers regarding referrals, preauthorization & pre-certification requirements

　　This job description is not all encompassing

　　Basic Qualifications:

　　Experience

　　Two (2) years of health care financial setting to include one (1) hospital setting Including one (1) year of office environment customer service OR two (2) years of post-high school related education OR combination of education and experience

　　Previous experience with cash handling required

　　Education

　　High School Diploma/GEDLicense,Certification, Registration

　　CPR

　　CHAA (Certified Healthcare Access Associate by the National Association of healthcare Access Management).

　　Basic Medical Terminology certificate

　　Notary

　　Additional Requirements:

　　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 wpm with above average accuracy

　　Must obtain cross training in all areas of the Patient Access Department (Admitting, Bed control, Central Check in, Labor and Delivery, Residential Treatment Center and ED) AND be willing to work in all areas

　　Ability to operate CRT, IBM compatible PC, Windows, such as MS Word/Excel, copier, fax, phone, and headset

　　Job requires continuous reading skills and the ability to handle a heavy volume of work

　　Knowledge of medical terminology, diagnostic related groupings (DRGs/MSDRG's), diagnosis code (ICD-9-CM) and common procedure terminology (CPT 4/APC) codes to determine benefits and estimate service cost

　　Knowledge of Medicaid, Medicare, and other government and insurance/payor requirements

　　Knowledge of State and Federal regulations governing healthcare encounters, such as HIPAA, State worker's compensation, third party liability for accidents, EMTALA and etc

　　Knowledge of and skill in the use of automated Patient care systems for admissions, registration, and basic medical records functions

　　Knowledge of state and federal regulations regarding funding resources

　　Knowledge of organization's and/or facility based billing systems

　　Knowledge of department procedures and established confidentiality policies

　　Knowledge of communication techniques with ability to listen actively and respond to fellow employees/customers in a timely, competent manner both verbally and non-verbally

　　Preferred Qualifications:

　　One (1) - two (2) years of higher education preferred

　　Previous experience with EPIC applications preferred

　　Previous hospital or ambulatory clinic registration experience

　　COMPANY: KAISER

　　TITLE: Representative, Patient Access II-KSMC

　　LOCATION: Hillsboro, Oregon

　　REQNUMBER: 1219880

　　External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.