Patient Access Rep Certification
Everyone in the medical field has some kind of diploma or certification to prove that they can do their job. In our field we have some certifications for specific tasks that are done such as coding. Those in the coding area are generally required to have a certification in medical coding in order to get a job. It wasn’t always like that. When I first started in the field anyone who was willing to learn the codes was given the job. The job didn’t pay as much as it does now and often the coders were the ones who didn’t fit in anywhere else. Medical coding is generally a solitary job done on the the computer after reading through doctors and nurses notes to determine what the patient had done, what tests were performed and the diagnosis or the reason why the patient was seen. Medical coding is used in the medical office, clinic and hospitals. All types of medical and psychiatric medical offices and facilities now require that the coding person be certified and/or educated in the medical coding field in order to ensure that their billing has the correct codes and that they get the most reimbursement for their services.
You can get certified for coding by attending classes at the local community college, sign-up at the local vocational tech school, go online and attend classes or be grandfathered in with many years of experience. The smaller doctors offices have personnel who have been doing the coding for the billing area for years and have learned through books, articles, attending seminars given by insurance companies, etc. If they have to get a job elsewhere or move to a larger city they will need to take the certification exam.
Now for the rest of us in the accounts receivable area including admissions, front-office, billing, insurance follow-up, collections and the like are trained “on-the-job”. I started out as a temp in a hospital because I was taking some accounting courses at the local community college and someone took a liking to me. I did what I was told, how I was told and had a willingness to learn and to work hard. It took me 6 months to learn a new aspect of each of the jobs I was assigned until I had them down and was training someone else to do the job before I was moved again. I ended up working in every phase of accounts receivable including, billing, collections, posting, admissions and precertification. I also learn to do coding for a psychiatric doctors office and then a facility by reading material from insurance companies and attending seminars.
Today things are still about the same for the insurance follow-up, admissions, and precertification areas. The billing and coding area have a certification exam sponsors by various groups and insurance companies to improve reimbursements for medical facilities and improve relationships with the insurance companies that the medical facilities are contracted with. One of the standards that is followed by almost everyone is Medicare. Medicare determines the basis for what is acceptable for billing including the forms that are used, the codes that are used for procedures, tests and diagnosis and what amount should be reimbursed. Most of the government insurances including Medicaid, Tricare, ChampVa and Veterans Administration have very similar rules that must be followed in order for the medical facility or doctors office to be paid and at what rate. Hospitals are required to be certified by the local health department and often are encouraged to follow the standards set out by JCAHO (Joing Commission on Accreditation of Healthcare Organizations). Hospitals are not required to follow their standards but are strongly encouraged to do us. Most, if not all, private insurance companies have integrated those standards within their own rules as well. Once you are familiar with Medicare and what they require in regards to collection of patient information, billing, coding and the like you will be able to make small adjustments for the others.
All of this is just to get to the point that we as patient access reps, patient account reps, admission clerks, patient access specialists or whatever your employer uses to call your job does not require certification only knowledge and the willingness to learn. The problem with that is that we cannot demand a higher paying wage for all of our knowledge. Sure, if you already have a diploma or years of experience you can go to a new employer and demand a higher starting salary than what a beginner might get but if we are “CERTIFIED” or have a certification in the field we should demand higher pay for our experience and our willingness to take a test to prove we actually know what we are doing. Once such exam is offered by the NAHAM – National Association of Healthcare Access Management. They offer a 2 certification exams one for the Certified Healthcare Access Associate and another for the Certified Healthcare Access Manager. They have a PDF Booklet on the requirements for the tests, how much it costs, etc. I believe that if more of us were willing to take this test we would be able to require better training, get better pay and finally be recognized as a vital part of the medical community!
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