The Patient Access Specialist I is an entry level position and is responsible for the accurate and efficient admitting, registering, bed placement, and financial analysis activities for all patients upon arrival to the healthcare system, including initiation of activities necessary to comply with managed care contracts and CMS regulations. Position is responsible for responding in a professional and courteous manner to all patient information inquiries, greeting and initiating the registration process upon patient's arrival. Position is responsible for the review of past account balances, notifying patient of their financial responsibility, and collection of these balances. This includes supporting their department in meeting the pre-collections goals defined by revenue cycle management. Review accounts with inadequate financial coverage for the purpose of coordinating with financial counseling services and facilitating an application for State Agency or Charity. In addition, Patient Access Specialist I must have comprehensive understanding of the healthcare system patient access policy and procedures as well as enforce established requirements and processes. The Patient Access Specialist I demonstrates empathy and professionalism as reflected by courteous actions, maintenance of confidentiality and appropriate presentation of self; consistently exhibits excellent oral and written communication skills; possess the knowledge and skills necessary to provide interactive communications appropriate to the age of the patient being served; interact appropriately with third party payers and other departments; and have the ability to relate well to people of a broad socio-economic mix. Strong organizational skills, ability to multitask, work in a fast pace environment and a commitment to teamwork are essential. Must have ability to work closely in a clinical setting involving some stressful situations, personal flexibility; moderate sitting, standing, stooping, bending and moderate work at portable computers required. Position must demonstrate excellent computer skills.
Required: High School Diploma or equivalent
Preferred: Prefer graduate of Medical Secretary Program
Demonstrated ability to read, write, arithmetic, multiplication/division including fractions and decimals. Strong computer skills, excellent customer service skills, interpersonal communication and telephone etiquette are required. Demonstrate ability to multitask and manage high volumes. Computer, fax machine, copier, multiline telephone.
Knowledge of basic registration and third party payer preferred. Preference for work experience in a physician front office or insurance/healthcare call center. Medical terminology, and basic knowledge base of CPT and ICD-9 codes, insurance coding and billing knowledge,
Position Requirement(s): License/Certification/Registration
Preferred: Certified Healthcare Access Associate from NAHAM
Department Position Summary:
Register and activate scheduled patients by gathering all demographic, financial, and pertinent information necessary to meet all regulatory and billing requirements.
Register and activate walk-in, add-on, and emergency room patients by gathering all patient demographic financial and pertinent information necessary to meet all regulatory and billing requirements.
Verify insurance eligibility and benefits for scheduled outpatient and inpatient patients.
Compute patient liability at point of registration
Communicate and collect patient financial liabilities.
Review prior bad debts and request payment of outstanding prior bad debt.
Alert Financial Advocates of accounts with financial clearance issues. Document patient liability and financial clearance status to ensure timely processing at the point of service.
Demonstrate excellent verbal and action related customer service skills to our patients, physicians, visitors.
Performs registration and Check-in Functions
Ensure patient medical record numbers are correct for the patient by validating patient name, social security number, and birth date and comparing to the master patient index.
Collect and enter patient demographic and insurance information into appropriate registration screens.
Required forms are completed and in place (ABNs, financial assistance, consent, etc.)
Two patient identifiers are obtained according to Red Rules and procedures
Patient financial liability is communicated clearly to the patient.
Ensure the patient receives and comprehends their Patient Rights.
Verify insurance eligibility and benefits including patient liability
Verify insurance eligibility and benefits to by utilizing integrated insurance verification system, payer websites, and telephone calls to payers.
Document insurance eligibility and benefits in the appropriate registration insurance verification and benefits fields.
Validate pre-certification requirements and pre-certification status.
Document pre-certification status in registration pre-certification field as outlined in department procedures.
Calculate patient liability using insurance verification information and pricing estimator tools.
Document patient liability in appropriate fields in patient registration system as outlined in department procedures.
Process and document patient financial liabilities, estimations, and payments as defined by central access procedures
Document financial clearance issues as defined in the department procedures
Maintains current working knowledge; adheres to Access policies and procedures; performs problem solving.
Initiative is demonstrated related to development and maintenance of an up-to-date working knowledge of insurance and access practices.
Practice/procedure changes are implemented in a timely and correct manner.
Management is promptly advised of unresolved problems or patient needs, including issues with cash/credit/checking processes.
Organizational resources, including access ability to newsletters and emails are routinely accessed for information and updates related to access functions.
Maintains a yearly average of 95% with accuracy and quality with defined HIS and patient access technology solutions
Requests from management and support functions are carried out in a timely fashion
Complete special projects as assigned according to the established time frames.
Prepares and maintains reports of results as requested.
Identifies and reports equipment problems which require maintenance or repair.
Performs other duties as assigned
Maintain confidentiality of information of the department and demonstrates excellent interpersonal skills
Maintain confidentiality of departmental information according to established procedures with no reported errors.
Release confidential information only in accordance with the confidentiality policy and/or approval of the Director.
Maintains a consistent positive, professional demeanor projected through verbal and non-verbal communications.
Information for patient and staff is delivered in a manner that is supportive, timely, and understandable.
Interpersonal conflicts are resolved using appropriate methods and organizational resources.
Relationships with staff in other work areas are fostered to meet internal and external customer needs
Appropriate resources throughout the Organization are used consistently to meet customer needs.
Positive working relationships with peers, management, and customers are maintained at all times.
Accountability for actions and decisions are demonstrated in daily work
Constructive input is offered to support the work unit.
Assist in delivering high quality health care services in a professional, compassionate, and courteous manner while respecting the dignity and individuality of each person who comes in contact with the organization by following Erlanger's Take Pride Standards in accordance to its Mission, Vision, Core Values, Keys to Service, Steps to Service, and Professional Appearance and Conduct.
Maintains patient privacy and confidentiality at all times according to established procedures.
Follow the Professional Appearance and Conduct and the Erlanger departmental dress code.
Communicates effectively and courteously answering assigned telephone lines within three rings identifying self at all times.
Assist visitors and patients in giving directions and information.
Communicate effectively and courteously with visitors, physicians, patients, and employees.
Introduces self and position to patient, families and visitors at all times.
Assess environment for safety hazards which could harm patients, visitors, or other hospital employees and report hazards to appropriate supervisors.
Collaborate with departments and outside agencies to meet the identified needs of the patients and organization.
Knowledge and performance of the Code of Conduct Standards
The incumbent demonstrates a commitment to high level of professional and ethical standards in his/her daily activities, consistent with the Code of Conduct and related to Erlanger policies.
The incumbent maintains integrity in business activities by following legal standards, maintaining confidentiality of patient and business information and reporting known or suspected misconduct.
The incumbent has completed the required annual general compliance training and any department specific training, as appropriate.
The employee honors Erlanger's Mission Statement, Vision Statement, and Core Values. The incumbent understands:
That Erlanger provides the highest quality of care to the community through respect, dignity, and compassion regardless of race, creed, national origin or the individual's ability to pay and;
That Erlanger provides leadership in pioneering new services through increased allocation of resources for research and education.
Mission: To serve the community by delivering a positive experience to our patients, families, and physicians by expediting care in a timely, personalized and compassionate manner while honoring Erlanger's core values of H.E.A.R.T. ; Ensuring the integrity of all job responsibilities are executed with the highest of quality standards, confidentiality, and security of patient information, identity, which enhance the hospital's revenue cycle operations throughout all registration functions and all its support processes.
Vision: Patient Access Services strives for excellence in quality, integrity, efficiency, and customer service through H.E.A.R.T.
R.E.S.P.E.C.T.: We will fulfill the mission and vision by adhering to the Standards of R.E.S.P.E.C.T.