Patient Access Specialist I

Overview

Our Patient Access Specialist assists in providing access to services provided at the hospital and/or other service area. Processes registration information for the patient visit, obtaining patient demographic and third party information with a high degree of accuracy, and performs financial collections.  Performs the timely completion, preparation, and deployment of legal, ethical and compliance related documents that must be presented and thoroughly explained to the patient at the time of registration. Maintains knowledge of JCAHO, Patient Rights and Responsibilities, HIPAA, HMOs, Commercial Payers, and departmental / system policies and procedures. Provides Mammography Screening scheduling services to patients. Work may be performed in a patient care area. Serves as a liaison between ancillary departments and other Patient Access Services areas.

Qualifications

Education:

High School diploma required. 

 

Licensure/Certification/Registry:

Must successfully complete assigned annual education through Healthcare Business Insights.

 

Experience:

One (1) years of business office experience, preferably in the areas of Patient Access, billing, collections, insurance principles/practices, or accounts receivable. Completion of 12 (twelve) hours of coursework in a business or healthcare related field of study may be considered in lieu of business office experience. Previous experience in Patient Access is highly desirable.  

 

Other Knowledge/Skills/Abilities:

• Knowledge of all tasks performed in the various Patient Access Service areas is necessary to provide optimum internal and external customer satisfaction and provide the opportunity for accurate reimbursement. 
• Demonstrates superior patient relations and interpersonal skills; demonstrates an appropriate level of mental and emotional tolerance and even temperament when dealing with staff, patients and general public, using tact, sensitivity and sound judgment; promotes a positive work environment and contributes to the overall team efforts of the department and organization.
• Working knowledge of computers is required, with the ability to enter and retrieve data, and electronically notate registration software, and other required applications/systems.
• Must demonstrate detail orientation, critical thinking, and problem solving ability.
• Must demonstrate excellent oral and written communication and customer service skills, with ability to maintain a calm and professional demeanor in high stress situations.
• Demonstrated ability to remain flexible, and consistently exercise sound judgment and initiative in very stressful situations.
• Ability to effectively manage competing priorities and work independently in a rapidly changing environment.
• Must demonstrate ability to educate, persuade, and negotiate effectively with patients and families.
• Knowledge of medical terminology, medical procedural (CPT) and diagnosis (ICD 10 CM) coding, and hospital billing claims preferred, but not required.

Responsibilities

• Completes all steps of pre-registration/registration; verifies patient identity and demographic information through appropriate tools. Identifies/captures appropriate health insurance benefit eligibility based on contract/regulatory differentiation. Facilitates appropriate billing of claims and hospital reimbursement. Obtains and validates proper consent for patient treatment.
• Schedules patients for Mammography procedures efficiently, effectively, and according to established protocol for modality, location, facility capabilities, insurance requirements, type of exam, patient preferences, and urgency.
• Educates patients/others regarding the resolution of billing, private pay options, collection efforts, coordination of benefits, third party and governmental payment criteria, insurance coverage, payments, and denials. May serve as a liaison between external resources and patients on issues requiring SMH involvement.
• Coordinates with SMH Patient Financial Services, Utilization Management, physicians, and medical offices to ensure consistent financial documentation across the enterprise, and an interdisciplinary approach to patient and organizational needs.
• Adheres to all CMS Conditions of Participation regulations and Section 1154(e) of the Social Security Act regarding delivery, explanation, and acquisition of patient/designated representative signatures.
• Verifies medical necessity, and obtains appropriate signature on Advance Beneficiary Notice of non-coverage (ABN) per CMS regulations at points of patient access.
• Negotiates with patients and families to collect patient co-pays and/or deposits at point of service. Supports Patient Access