Job Information: Patient Access Specialist I-II (DH3534) Job

The primary purpose of the patient access specialist is to schedule and register patients by accurately collecting and analyzing all patients’ demographic, third party coverage (i.e., insurance), and clinical data elements. Incumbent interviews patients and assists them in completing required forms to process medical, dental and pharmacy billing claims. Incumbent is responsible for data integrity to further expedite third party reimbursement and optimize customer satisfaction. This position requires the ability to work under conditions of frequent interruptions and willingness to work flexible schedule. Incumbent also initiates and carries out a variety of clerical duties such as scheduling, changing and cancelling patient appointments, building of provider schedules.

ESSENTIAL FUNCTIONS:

Reviews, updates and maintains all patient data in multiple patient accounting, registration and scheduling systems by initiating the completion of forms required for billing and admissions.
Interviews patients to obtain pertinent registration information, assures document scanning, retrieving and editing, and patient identification to determine patient’s insurance coverage, limitations and communicates to patient any co-pays or deductibles for collection.
Identifies patient’s potential financial liability for a specific service and identified patients at risk for inability to meet financial liability; Makes referral to an appropriate agency or department. Provides an overview of options available to patients/families by assessing patient understanding of registration process to determine appropriate response to patient’s questions and applications and communicates appropriate information needed to complete patient’s eligibility process.
Collects cash payments for pharmacy and medical services and complete necessary reconciliation in accordance to fiscal policy.
Performs insurance verification and prior authorization for patients prior to patient’s schedule appointment or procedure.
Assists patients in completing and updating forms required for medical records, third party insurer and the facility.
When assigned, performs all activities of an admitting office (i.e. admitting, discharge, transfer, pre-admissions, pre-verification, etc.) for all patient types; responsible for Admissions Discharge Transfer (ADT) data integrity for admissions, referrals, including Emergency Room (ER) admission to the units (i.e. ICU, PEDS, ACU and OB), and notifies all appropriate department of transfer arrangements.
Identifies and pre-authorizes patients whose health benefits are subject to prior approval to determine the extent of health care for both inpatient and outpatient care.
Collaborates with various departments to expedite patient services and improve patient satisfaction.
Incumbent will serve patients and visitors by welcoming and greeting them in person and or telephone; answering or referring inquiries; directing patients, visitors.
Works in shifts (rotational including call back schedule is only for Emergency and Inpatient).
Intake and coordinate motor vehicle accidents/worker’s compensation claims visits that are encountered during shift to appropriate personnel.
Follow all guidelines in regards to patient identification and income screening for the non-eligible Medicaid patients according to provided technical training information.
Work with software systems for clinical, medical, dental, pharmacy and other healthcare office systems.
Assures required requisitions for various departments are completed and routed as appropriate. Insures unit is stocked with appropriate forms and supplies. Retrieves and prints laboratory reports, health summaries, medication lists and other patient records as indicated.
Responsible for electronic health records data entry pertinent to patient service role.
Perform other duties as assigned.

MENTAL AND PHYSICAL EFFORT

The physical and mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to individuals with disabilities to perform the essential functions.

Physical:

Work is mostly sedentary, with some walking, standing and bending while interviewing patients and preparing the appropriate paperwork for treatment of a patient or initiating a chart. May lift up to 25 lbs in the work area.

Mental:

Must be able to effectively communicate to the patient what specific information is needed, the reason for requesting such – information and be able to ascertain that it is accurate as possible. Consequences of obtaining inaccurate information may delay necessary medical treatment, delay billing process and cause unnecessary frustration and problems.


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