Patient Access Specialist

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The University of Miami/UHealth Department of Clinical Access has an exciting opportunity for a full-time Patient Access Specialist.

Core Job Summary:

The Patient Access Specialist (On-Site) is responsible for coordinating a wide range of complex duties that support front end revenue cycle and clinic functions for hospital and clinic operations that impact the patient experience. Serves as functional expert for department peers and oversees team adherence with established policies and procedures.

Core Responsibilities:

• Obtains, confirms, and enters demographic, financial, and clinical information necessary for financial clearance of scheduled patient accounts.
• Contacts patients’ families or physicians’ offices to obtain missing insurance information.
• Verifies insurance and confirms insurance eligibility of patient coverage benefits, notifying patient and referring physician in the event of failed eligibility.
• Collaborates with scheduling departments to identify add-on patients.
• Obtains necessary authorizations, pre-certifications, and referrals.
• Notifies patients of liabilities prior to date of service and collects funds.
• Maintains appropriate records, files, and accurate documentation in the system of record.
• Serves as a lead resource for lower-level Patient Services staff. Recommends new approaches to management for enhancing performance and productivity.
• Deploys critical thinking while responding to a variety of technical issues from patients, physicians and employees via phone, email, web messages, fax, or email.
• Works independently and deals effectively with stress, due to heavy workload and the handling of complex patient inquiries.
• Serves as a role model, facilitator, and coach in developing a culture of compassion and caring through building healthy relationships among staff, patients, and families.
• Projects a professional appearance and pleasant demeanor creating a welcoming atmosphere.
• Adheres to University and unit-level policies and procedures and safeguards University assets.

Department Specific Functions:

• Tier 1 essential worker that provides critical functions that cannot be paused in traditional and non-traditional healthcare settings 
• Subject to potential contact with patients who can transmit infectious diseases.
•   Coordinates wide range of hospital and clinic front end revenue cycle and clinic support functions from prearrival to post discharge services. 
• Obtains, confirms, and accurately enters demographic, financial, and clinical HIPAA protected information. 
• Assists in monitoring staff productivity and quality of work through proactive review of key performance indicators.  
• Serves as functional expert resource and provides on the job training for Patient Access Service team. 
• Navigates multiple systems simultaneously and independently to service patients promptly in a fast paced, constantly changing environment. 
• Monitors and maintains all work queues. 
• Assists patients in navigating self-serve technology options in person or remotely.
•   Performs pre-service validation prior to patient’s appointment for in person or virtual visits.  
• Conducts critical communication with patients or legal guardian facilitating the understanding of and obtaining signature on multiple consents, assignment of benefits, and notices including but not limited to Consent for Treatment and Conditions of Admissions, Advance Directives, HIPAA, No Surprise Billing, Good Faith Estimate, Off Campus Medicare Co-insurance, ABNs, and MSPQ, prior to services being rendered. 
• Provides financial counseling services at check-in, creates estimates, explains benefits, and notifies patients of self-pay liabilities including previous balances, and collects funds. 
• Collaborates with providers and clinical schedulers in coordinating and scheduling complex follow up care onsite or remotely. 
• Handles high volume of inbound and outbound calls to and from patients and customers, listening to customers’ needs and providing helpful solutions. 
• Processes transactions quickly and accurately in a fast-paced environment. 
• Processes large amounts of currency and performs end of day cash-drawer reconciliation, including bank deposits. 
• Interfaces effectively with all members of the healthcare team. 
• Strives to meet all established key performance indicators: Co-pay, Previous Balances, Estimate Collections, Patient Satisfaction, Accuracy Rates, and Processing Time. 
• Maintains a close working relationship with all members of the clinical team to ensure a seamless check in and out clinic flow and positive experience for patients and caregivers. 
• Identifies, analyzes, and interprets complex data and resolves operational problems.
• Provides management with necessary updates on progress and changes in scope, schedule, and resources. 
•   Other duties as assigned. 

AREA SPECIFIC 

ER  

• Must possess a good understanding of the unique characteristics and operations of the Emergency Room, in order to proficiently support the Emergency Room. 
• Must be flexible and adjust to rotating schedules, evenings, weekends, and holidays. 
• Able to perform ADT functions (as described under Admitting section) afterhours, weekends, and holidays. 
• Must adhere to PPE requirements as dictated by the specific situation. 
• Proficient knowledge of ASAP module. 

ADMITTING 

• Must possess a good understanding of the unique characteristics and operations of Admitting, in order to proficiently support the Admitting Dept.  
• On-call and rotating schedule for evenings, weekends, and holidays. 
• Explains and obtains patient acknowledgment for all required regulatory documents including but not limited to the HIPAA Facility Directory Form, and CMS MOON, HOON, and IMM notices.  
• Obtains information from patient to complete Patient Self Determination Checklist and collects and scans pertinent documents.  
• Proficient knowledge of ADT module. 
• Responsible for obtaining, confirming, and documenting eligibility and benefits, and providing health plan admission notification.   
• Responsible for pre-admissions log to include benefits, specialty, and financial clearance.  
• Coordinates with bed control on bed availability.  
• Collaborates with Transfer Center on all incoming transfers to finalize transfer requests.  
• Responsible for processing admissions orders received via in-basket messaging. 
• Extensive collaboration with providers, nursing unit, and utilization review department in coordinating admissions.  

CTU 

• Must possess a good understanding of the unique characteristics and operations of Admitting, to proficiently support CTU. 

HOSPITAL BASED CLINIC 

• Must possess a good understanding of the unique characteristics and operations of the hospital-based department/clinic/division to support the hospital-based practice. 

PRACTICE BASED CLINIC 

• Must possess a good understanding of the unique characteristics and operations of the department/division, to proficiently support the practice. 

REMOTE BASED 

• Must possess a good understanding of the unique characteristics and operations of remote based call center operations to proficiently support all Front-End Revenue Cycle and Clinical Support remote functions. 

This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.

CORE QUALIFICATIONS                                                                                                         

High school diploma or equivalent required

Minimum 3 years of relevant experience

Knowledge, Skills and Attitudes:

• Skill in data entry and completing assignments accurately and with attention to detail.
• Ability to communicate effectively in both oral and written form.
• Ability to process and handle confidential information with discretion.
• Ability to analyze, organize and prioritize work under pressure while meeting deadlines.
• Outstanding interpersonal skills with a commitment to service excellence
• Able to handle multiple tasks, software systems, and technologies simultaneously.
• Ability to establish and maintain effective working relationships with patients and staff.
• Knowledge of generally accepted accounting procedures and principles
• Ability to plan, organize, measure, and integrate priorities and deadlines. 
• Computer literate with the ability to quickly adapt and acquire proficiency in utilizing multiple systems and technologies simultaneously. 
• Ability to interact and work effectively with patients/customers of all ages and cultural backgrounds. 
• Adherence to punctuality and attendance standards, remaining flexible to meet departmental needs and ensure appropriate clinic flow. 
• Able to be available 30 minutes prior to opening and after clinic ends, which fluctuates depending on clinic and provider, in addition to weekends, evenings, holidays, and during disastrous events (e.g., hurricanes, pandemics, etc.) 
• Outstanding interpersonal and customer service skills with a commitment to service excellence. 
• Proficient knowledge of health care regulatory guidelines and compliance requirements pertaining to patient access including but not limited to: OSHA, HIPAA, JC, AHCA, EMTALA, and CMS. 
• High level of critical thinking and analytical skills required to evaluate systems’ requirement and to develop methodologies and/or make recommendations to existing systems to maximize efficiency and performance. 
• Skilled in examining and reengineering operations and procedures, formulating policy, and developing and implementing new strategies and procedures. 
• Knowledge of generally accepted accounting principles with excellent mathematical and cash management skills. 
• Skill in completing assignments accurately with attention to detail. 
• Ability to identify, analyze, interpret complex data, and resolve operational problems by applying sound judgement and critical thinking.
• Ability to anticipate and react calmly in emergency situations and handle difficult and stressful situations with professional composure.
• Ability to establish and maintain effective collaborative working relationships with clinical and non-clinical teams to ensure a positive patient experience. 
• Ability to inspire, influence and motivate team members both onsite and remotely to meet goals. 

Any relevant education, certifications and/or work experience may be considered.

The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.

UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for.

The University of Miami is an Equal Opportunity Employer. Applicants and employees are protected from discrimination based on certain categories protected by Federal law.

Job Status:

Full time

Employee Type:

Staff