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Patient Access Specialist
3 months ago
The Patient Access Specialist will maximize reimbursement by efficiently scheduling and pre-registering patients for their upcoming service at the hospital as well as promoting accuracy and timeliness of data processing and maintaining customer services objectives.
This role includes scheduling the patient, updating insurance and demographic information, performing medical necessity checks as appropriate, verifying the authorization was initiated by the physician's office, and initiating financial account processes and educating patients regarding policies, procedures, expectations and financial responsibilities.
Provides outstanding and professional Customer Service to all internal and external customers.Description
Consistently practices Patients First philosophy and adheres to high standards of customer service. This includes setting an example to peers, coworkers, etc. by fostering a team atmosphere
Responds to questions and concerns. Forwards, directs, and notifies Team Lead or Operations Coordinator of extraordinary issues as necessary
Maintains patient confidentiality per HIPAA regulations
Specific Responsibilities Provides exceptional customer service to patients which establishes a positive first impression of hospital. Exceeds all consumer requests and alerts management of issues or concerns that require escalation
Correctly identifies and collects patient demographic information in accordance with organization standards
Interacts with various hospital departments and physician's offices to effectively schedule and direct patients through the hospital systems in a patient/customer-friendly manner
Reaches out to patients to schedule an appointment as defined
Performs medical necessity checks as necessary for scheduled services, communicates options to the patient if appointment fails
Informs patients of any issues with securing the financial account for their encounter
Completes out-of-pocket estimations as requested by patients
Provides training and education as needed
Manages work schedule efficiently, completing tasks and assignments on time
Completes other duties assigned by the manager. Cross-training between various departments will take place to ensure coverage
Participates in Quality Assurance reviews to ensure the integrity of patient data information
Uses effective service recovery skills to solve problems or service breakdowns when they occur
Utilizes department and hospital policies and procedures to complete assigned tasks
Adherence to all department policies and compliance requirements
Avoids putting patients in financial or safety risk
Other duties as assigned
Communication and Collaboration Communicate information to the patient regarding questions about physician referrals, insurance referrals, and consultations. Collects authorization numbers in appropriate systems as applicable
Provides a professional and constructive environment for communication across units/departments and resolves operational issues. May attend intra/interdepartmental meetings which involve walking within hospitals campus
Communicate customer satisfaction issues to appropriate individuals
Demonstrates teamwork by helping co-workers within and across departments. Communicates effectively with others, respects diverse opinions and styles, and acknowledges the assistance and contributions of others
Interacts with internal customers to provide excellent support service to staff in departments that provide direct patient care
Accommodates all levels of communication ability
Technology Utilizes multiple online order retrieval systems to verify or print the patient's order
Verifies insurance eligibility and benefit levels through the use of online tools (NDAS, ASF, etc.) or over the phone as necessary
Completes accurate handoff instructions and notes to scheduling staff, by noting appropriately in Epic
Demonstrates ability to use all computer applications efficiently and to the capacity needed in this position
Runs real-time eligibility (RTE) on all patients to verify insurance and follows out-of-network policies as applicable
Sends quality Epic Messages/Telephone encounters that are descriptive and grammatically correct
Efficiency, Process Improvement, and Business Growth Proactive in preventing issues with patient visits by double-checking type of test preps required, assuring no conflict with other tests, verifying time and location, communicating relevant information, verifying documenting order retrieval in notes for check-in person, ensure there are no duplicate patient records
Understands minimum data set required for a complete registration, collects and verifies critical data, and updates that information into the registration system
Understands departmental and individual quality metrics
Proactively analyzes account activity, identifies problems, and initiates appropriate actions/resolutions
Evaluate procedures and suggests improvements to enhance customer service and operational efficiency
Participates in departmental quality improvement activities
Provides ideas and suggestions for process improvements within the department
Monitors registration and scheduling, including insurance verification to ensure processing within prescribed quality standards
Adjusts processes as needed to meet standards
Uses organizational and unit/department resources efficiently
Acts as a training resource for new staff and a resource for coworkers, sharing process and workflow information
Understands that schedule may change to reflect shifting business needs
Evolves and learns as healthcare policies change
Required:
High School diploma or equivalent
2-3 years of customer service or medical office experience
Excellent interpersonal, verbal, and written communication skills
Proficiency in computer data entry/typing
Excellent verbal and written communication skills
Ability to read, write, and communicate effectively in English
Basic Computer Skills
Ability to type 40 wpm
Ability to multi-task
Customer service-oriented
Excellent organizational, time management, analytical, and problem-solving skills
Preferred:
Additional education
Additional language skills
Healthcare finance and/or healthcare insurance experience
Knowledge and experience in a healthcare setting, especially patient scheduling and/or registration
Population Served:
Internal: Incumbents in this position communicate with physicians and all levels of employees in hospital
External:
Patients and their families and representatives, physician offices, other health care agencies, and health care providers, insurance companies and financial agencies, and contracted outside services
