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.
- 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 regard 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.
- Ensure proper PPE is worn at all times while on duty including but not limited to, face mask, gloves, gown, isolation gown, NIOSH-approved N95 filtering facepiece respirator or higher, if available), and eye or face shield.
- Complete all donning and doffing tasks in a safe acceptable method and discard of used PPE accordingly. (see CDC website for most current updates)
- Complete task training for all routine cleaning and decontamination processes for all surfaces contaminated by a communicable disease to ensure a high level of patient, visitor, employee and external customer satisfaction.
- 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: This position requires prolong periods of sitting, walking, standing, talking, hearing and use of hands to finger, handle, or feel. while interviewing patients and preparing the appropriate paperwork for treatment of a patient or initiating a chart. Often this position will be required to lift 10-25 pounds during the workday. There are occasionally times when it is required to be able to push/pull and lift up to 50 lbs. in the work area. This position occasionally requires the ability to stoop, kneel, crouch, and crawl. Must be able to reach with hands and arms. This position requires the ability of close, distance, peripheral, and depth perception vision. Must be able to adjust visual focus as needed. Employee must be able to perform prolonged times of repetitive motion actions using both hands; grasping simple/light; and fine dexterity. There will be rare times when repetitive motion actions will be required of both feet; and, use of both hands in grasping firm/heavy. This position requires the ability to hear alarms on equipment; client calls; instruction from physicians/department staff; and, overhead pages from a loudspeaker.
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.
This job requires the exposure to the following environmental conditions occasionally: wet, humid conditions (non-weather); work near moving mechanical parts; toxic or caustic chemicals; extreme cold (non-weather); extreme heat (non-weather); risk of electrical shock; risk of radiation; and, vibrations. This job often is exposed to fumes or airborne particles. This position does work in a healthcare setting were exposure to a diverse of infectious disease is possible.
High School diploma or GED, college credit is a plus but not required
Patient Access Specialist I:
Must have six (6) months of experience working in a fast-paced office environment with the ability to manage and prioritize multiple assignments, completing tasks and demands while meeting tight deadlines.
Patient Access Specialist II:
Must have two (2) years of experience working in a fast-paced office environment with the ability to manage and prioritize multiple assignments, completing tasks and demands while meeting tight deadlines. Experience with Stockell or similar patient financial services software.
Must have and maintain current BLS certification by the American Heart Association, if none, obtain within 3 months from date of hire.
Other Skills and Abilities:
A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers. All employment references must address and indicate achievement in each one of the following areas:
- Must have excellent customer service skills, personal and telephone communication skills
- Proficient knowledge and ability to use computer software
- Demonstrate through work history the ability to complete special projects; the ability to meet departmental deadlines, analyze, research and troubleshoot. Demonstrates the ability to solve problems following chain of command
- Experience with special projects to meet department demands, must work independently, analyze, research, troubleshoot and resolve issues
- Positive communication and working relationships with others
- Possession of high ethical standards and no history of complaints
- Reliable and dependable; reports to work as scheduled without excessive absences
- Ability to handle sensitive and confidential information
- Must be proficient with typing and accurate spelling and grammar
- Ability to work independently with minimal to no supervision
- Ability to work under conditions of frequent interruptions and availability to work a flexible schedule
- Possesses and employs an ability to communicate with patients and families during time of emotional and physical stress.
- Responds positively to supervision to enhance and improve work performance outcomes.