Patient Access Specialist

Variable (United States of America)

Patient Access Specialist - HBSThe Patient Access Specialist is responsible for performing duties associated with Scheduling, Pre-registration, Registration, Insurance Verification, and Financial Counseling.   Accurately schedule patients being registered for a hospital service.  Obtain necessary documents required for scheduling and registration.  Promote good public relations at all times, extending a positive, cooperative and supportive service to patients, families and fellow colleagues.   Pre-register scheduled accounts via contact with patients, physicians or appropriate information sources. Create accurate and thorough registration records for each patient visit. Secure appropriate signatures, financial information and documents. Identify and collect patient balances. Screen for payer medical necessity requirements and benefit eligibility on appropriate accounts. Coordinate admission reservations and bed placement with nursing.   Obtain insurance eligibility, benefits, authorizations, pre-certifications and referrals for inpatient and outpatient, scheduled and non-scheduled visits. Update demographic and insurance information in the system as needed. Initiate collection process by contacting patients/representatives about date of service deductibles, co-insurance and co-payments. Establish financial arrangements with patients according to policy. Act as the primary documentation source for access and billing staff.   Interact in a customer-focused and compassionate manner to ensure patients and their representatives' needs are met, and they understand the hospital's financial policies.

- High School Diploma or GED equivalent required; Associate's or Bachelor's degree preferred
- Must complete Revenue Cycle Orientation courses within 6 months of hire
- Two years of related work experience preferred, preferably in healthcare or customer service environment utilizing the following skills:  
- Effectively communicating with individuals from varying socio-economic backgrounds and obtaining pertinent information
- Familiarity with medical terminology
- Ability to accurately verify demographic information and insurance benefits
- Ability to effectively operate office equipment (i.e., fax machine)
- Must have knowledge of computer programs such as Microsoft® Word and Excel
- Organizational and time management skills necessary to complete multiple tasks
- Must be customer-service oriented and able to effectively communicate and build relationships with Team Members at all levels in the organization. 
- Professionalism in interpersonal verbal and written communication skills with colleagues, physicians and ancillary department personnel is required
- Scheduling Responsibilities
- Maintains a knowledge of scheduling criteria for all procedures within department. 
- Works at a fast pace and maintains accuracy of details for each procedure scheduled.
- Schedules patient visits in a timely manner, ensuring that appointments along with all information are complete and accurate.
- Coordinate appointments as needed with other departments.
- Answers phone and provides excellent customer service. 
- Ensures and adheres to strict confidentiality when handling patient charts, records, and scheduling information. 
- Pre-Registration Responsibilities
- Ensures and adheres to strict confidentiality when handling patient charts, records, and scheduling information.
- Communicates with third-party payers to obtain authorizations/pre-certifications for patients' scheduled services as needed, documenting this information in the registration system.
- Collaborates with patients, other patient access staff, the clinical departments, and referring physician offices to ensure that all necessary information is obtained from patients before their scheduled services.
- Documents all information obtained during pre-registration activities to ensure patients' accounts are complete for forwarding to other departments.
- When necessary, refers uninsured, underinsured, and low-income patients to patient financial advocates to secure financial arrangements prior to service.
- Registration Responsibilities
- Enters patients into the patient tracking system upon arrival per department procedure.
- Interprets physician orders to determine service needs.  
- Collects and scans physician orders or verifies that complete and valid orders are on file for each patient. 
- Accurately and thoroughly collects, analyzes, and records demographic, insurance, financial, and clinical data in computer system.
- Ensures information source is appropriate.
- Reviews and explains all registration forms prior to obtaining signatures from patient or appropriate patient representative. 
- Ensures patient's identification band is securely fastened upon completion of the registration.
- Collects self-pay balances per department guidelines and posts collections to system.
- Ensures that all monies collected are secured or turned over to appropriate associates and cash drawers are balanced before closing.
- Refers patients to for in-depth financial counseling when needed. 
- Provides patients with financial assistance applications per department guidelines. Identifies payer requirements for medical necessity and pre-certification.
- Verifies compliance or completes the screening process, following department procedures for payment or non-payment responses.
- Insurance Verification Responsibilities
- Advises patients and/or family members of their financial obligation via all modes of communication.
- Obtains payment in full or secures adequate payment arrangements/eligibility and benefit information for both inpatient and outpatient accounts.
- Advises patients on expenses associated with service and informs patients of payment requirements.
- Secures payments or payment arrangements on self-pay accounts.
- Discusses third-party coverage with patient and arranges disposition of out-of-pocket balances due.  
- Advises patients as to their financial liability and assists them with insurance issues and activation of coverage.
- Provides superior customer service to the patient and family by assisting with completion of required paperwork and program applications, such as for Medicaid and Halifax Health's charity program.
- Serves as resource to CEA staff, Social Workers, and other hospital staff for identification of funding sources for health services for patients.
- Financial Counseling
- Demonstrates compliance with the Statement of Organizational Ethics and all policies related to the organization's Corporate Compliance Program as evidenced by attendance at applicable educational programs;
- consistently carrying out job responsibilities ethically and professionally;
- exhibiting ethical and professional workplace behavior and decision-making;
-  reporting any infractions using the appropriate chain of command and without fear of retribution.
- Completes annual learning requirements, reviewing fire safety and Isolation precaution policies, applicable code reviews, disaster plan reviews, policies on handling hazardous and toxic substances, and risk management issues.
- Demonstrates an interest in patient safety education and participates proactively in identifying problems and incidents in the department and throughout the hospital which place any patient, visitor, or staff member at risk or injury.
- Follows EMTALA, HIPAA, payer, and other regulations and standards. 
- Demonstrates a positive and friendly demeanor even in stressful situations to ensure a positive experience for all customers.  
- Communicates in a respectful, positive way with fellow colleagues.