Patient Access Account Specialist

Overview

Summary:This position provides all necessary functions to financial clear patient accounts for government and commercial accounts prior to the date of service. Perform all financial clearance functions, including insurance verification, authorization, collection and documentation of patient demographics, benefit analysis, financial counseling, and pre-service collections. Ensure follow up on authorizations for scheduled and Urgent/Emergent procedures and admissions until date of service or discharge for admissions. Must possess a proficient knowledge of Medicare (CMS) guidelines, as well as other Compliance Regulatory guidelines applicable to Patient Access, to include HIPAA, EMTALA and CMS guidelines for MSPQ. Monitor work queues for financial clearance and missing authorizations ensuring a payment source is identified and secured, resulting in a clean claim for billing. Act as the Subject Matter Expert (SME) to all employees within Patient Access and for testing of new or existing software and processes. Is responsible for providing the highest level customer service to patients, ancillary departments, payers and providers when financially clearing accounts. Provide coverage to other areas and hospitals as needed to minimize overtime and guarantee the patients receive services as needed without registration delays. Assist in the shadowing of Patient Access candidates and assist in training new hires.

Type of Opportunity: Full Time FTE: 1.000000 Exempt: No Work Schedule: Varied Days and Hours

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Qualifications

Other information:High School Diploma or GED

Education:Essential:* High School Diploma or GED

Responsibilities

Responsibilities:Customer Service and Caring Practices:*Achieve exceptional patient experience for patients and patient families by using CARES, AIDET and EPE tools.*Addresses and attempts to appropriately resolve complaints in the moment by using key words at key times and de-escalation processes.*Ability to manage conflict and appropriately request the help of a supervisor when needed.*Implement PROMISE and CARES behaviors in every encounter.*Educates patients for whom they speak regarding insurance benefits and liabilities.*Ensures accounts are financially cleared prior to date of service to alleviate patient concerns over hospital financial matters*Provides patients with financial options to ensure payer source for visit and allowing patients to make an informed decision.Encounter Components:*Performs the patient registration process. Manage the accurate collection of patient data which includes but is not limited to;*Obtain/confirm and enter demographic and other financial and clinical information necessary for final clearance of scheduled and Urgent/Emergent patient accounts.*Review Urgent/Emergent admission accounts for notification, financial clearance and authorization pre-discharge.*Obtain missing insurance information, to include policy number, group number, date of birth, and insurance phone number if not already identified in account.*Verify insurance for eligibility and benefits using online electronic verification system or by contacting payer directly.*Review and process work queues related to Patient Access pre-visit or urgent/emergent admissions, per department guidelines.*Review of accounts falling within the work queues to ensure the insurance information contains accurate policy ID#s, Group Name and Numbers, Subscriber information, Authorization numbers, as well as correct payer and Coordination of benefits prior to date of service.*Accurately document actions taken in the system of record to drive effective follow-up and ensure an accurate audit trail.*Maintain ongoing knowledge of authorization requirements and payer guidelines. Maintain a proficient knowledge of Medicare (CMS) guidelines as it relates to admissions and outpatient services. Ensuring compliance with admissions forms, benefit entitlement verification, and billing requirements*Ensure accurate completion of MSPQ prior to date of service.*Daily focus on attaining productivity standards; recommend new approaches for enhancing performance and productivity when appropriate.*Monitor and track Data Quality program to ensure errors are corrected prior to final bill and correct accounts as necessary.*Maintain appropriate records, files, and timely and accurate documentation in the system of record.*Work with Ancillary departments to ensure coding, diagnosis, and facility are authorized and in alignment.*Work with payers to ensure authorization is in place; initiating the auth when appropriate.*Coordinate efforts with Financial Advocates to secure payer source for current and future visits*Monitor work queues to identify late add-on accounts, ensuring completion of financial clearance processes prior to services t