Patient access specialist 1

Patient Access Representative

Responsible for the complete and accurate collection of patient demographic and financial information for the purpose of establishing the patient and service specific record for claims processing and maintenance of an accurate electronic medical record. Registers and checks-in patients and determines preliminary patient and insurance liability. Performs routine account analysis and problem solving. Resolves patient account issues. Initiates billing and rebilling of accounts as appropriate. Under limited supervision; determines need for and obtains authorization for treatment / procedures and assignment of benefits required. Provides information to patients concerning regulatory requirements. At point of service, provides estimated costs and patient responsibility, facilitating collection of co-pay, deductible and private pay balances.

Obtains, verifies and enters patient identification, demographic information, and insurance coverage into hospital information system(s), to ensure accurate and timely submission of claims. Determines visit-specific co-payments and collects out-of-pocket liabilities. Assists patients with questions regarding financial liability or refer to appropriate resource(s). Inform patients on cost of treatment, insurance benefits, resources for payment and financial assistance. Secures and documents payment arrangements. Obtains medical authorization or referral forms, if appropriate. Audit authorizations for accuracy and determine if delay / deny policy needs to be invoked. Utilizing key reports and tools to facilitate obtaining accurate insurance information. Educates patients / families on the use of registration kiosks or online systems. Identifies non-routine complex issues and escalates to Patient Access Lead for resolution. Assists in the training and education of colleagues upon hire and ongoing as new systems and processes are created. Maintains compliance with HIPAA and other regulatory requirements throughout all activities. Protects the safety of patient information by verifying patient identity to preserve the integrity of the patient record and ensures all records are complete, accurate, and unique to one patient. Is proficient at the use of automated tools and makes appropriate decisions related to the relationship of the action required and the tool used. Performs pre-registration and pre-admits. Communicates frequently with patients / family members / guarantors, and physicians or their office staff in the deployment of key activities. Interviews patients to collect data, initiates electronic medical records, validates and enters data related to procedures, tests and diagnoses. Determines need for appropriate service authorizations (pre-certifications, third-party authorizations, referrals) and contacts physicians and Case Management / Utilization Review personnel, as needed. Obtains and verifies the accuracy and completeness of physician orders for tests and procedures, which includes name, date of birth, diagnosis, procedure, date, and physician signature to minimize risk to hospital reimbursement. Accurately uses the patient search feature to find the correct patient information and disseminates data to clinical systems for patient care. Identifies required forms or templates based on the types of services patients will receive. At point of service, performs insurance eligibility and determines benefit verification, utilizing EDI transactions and payer web access, and calls payers directly. Documents information within the patient accounting system through insurance eligibility / benefit verification. Refers accounts identified as self-pay to benefit advocacy resources. Conducts data search of previous accounts or payment source history, when appropriate. Provides financial information and patient payment options. Informs patient / guarantor of liabilities and collects appropriate patient liabilities, including co-payments, co-insurances, deductibles, deposits and outstanding balances at the point of pre-registration or point of service. Documents payments / actions in the patient accounting system and provides the patient with a patient estimate of out-of-pocket costs and a payment receipt in the collection of funds. Acquires and explains necessary documents including patient identification, insurance cards, consent for treatment, assignment of benefits, release of information, waivers, ABNs, advance directives, etc. Identifies need for patient / guarantor signature based on patient encounter / visit. Scans appropriate documents.

Cross trains in various functions to assist in the timely delivery of department services. Performs routine duties relating to patient placement, which includes responsibility for bed assignments, transfers, and providing functional guidance as necessary. Utilizes Scheduling Booking Reports, Stop / Go Reports, Schedules, to facilitate daily patient activity and flow in support of the clinical departments. Analyze completeness and accuracy of records on these reports proactively and take action as appropriate. Analyze and problem-solves issues related to revenue cycle elements (charges, demographic information, guarantor information, insurance eligibility, coordination of benefits, authorization requirements) in response to patient inquiries and issues. Works to resolves these issues in a timely and appropriate manner including assisting with submission of patient centered claims to insurance carriers. Interprets data, draws conclusions, reviews findings and provides recommendations. Acts as subject matter expert and participates in special projects as directed by the Patient Access Lead. Other duties as needed and assigned by the manager. Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health's Organizational Integrity Program, Vision, Mission, Core Values, Standards of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior. Maintains good rapport and cooperative relationships. Approaches conflict in a constructive manner. Helps to identify problems, offer solutions, and participate in their resolution. Maintains the confidentiality of information acquired pertaining to patient, physicians, employees, and visitors to St. Joseph Mercy Hospital. Discusses patient and hospital information only among appropriate personnel in appropriately private places.

Performs other duties as assigned.

Required Education, Experience and Certification / Licensure

High school diploma or an equivalent combination of education and experience. Associate degree in Accounting or Business Administration highly desired.

Minimum of one year experience in a customer service role with financial responsibilities is required. Experience in health care, insurance, or managed care industries is highly preferred. Experience performing medical claims processing, financial counseling and clearance, or accounting is also highly preferred.

Completion of certification and skills competencies such as the Certified Revenue Cycle Specialist Professional (CRCSP) through the American Association of Healthcare Administrative Management (AAHAM) and / or Certified Healthcare Access Associate (CHAA) through the National Association of Healthcare Access Management (NAHAM) is preferred.

Required Skills and Abilities

Must have experience with the core offerings of the Microsoft suite (Word, PowerPoint, Excel). Strong communication skills both verbal and written, Strong critical thinking, interpersonal and problem solving skills. Strong data entry and organizational skills. Must be accurate and possess high level of attention to detail. Able to work independently and have good time management skills. High level of initiative. Able to work concurrently on a variety of tasks / projects in a fast-paced environment that is sometimes stressful with individuals that have diverse personalities and work styles. Able to set and organize work priorities and then adapt as business needs change. Able to comprehend and retain information and apply to work procedures to achieve appropriate service delivery. Knowledge of insurance and governmental programs, regulations and billing processes (Medicare, Medicaid, Social Security Disability, Champus, and Supplemental Security Income Disability), managed care contracts and coordination of benefits is highly desired. Working knowledge of medical terminology, anatomy and physiology, and medical record coding (ICD-10, CPT, HCPCS) is preferred.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.