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Patient Access Specialist I
2 months ago
Employment Type:
Full time
Shift:
Description:
An Opportunity to Join our Remarkable Care Patient Access Specialist awaits YOU
St. Joseph Mercy Health System (SJMHS) is one of the nation's top healthcare service providers, spanning five counties in Southeastern Michigan. SJMHS represents more than 2,700 physicians and 14,000 nurses and staff, and includes 5 Hospitals, 5 Outpatient Health Centers, 8 Urgent Care Facilities and over 25 Specialty Centers. Saint Joseph Mercy Health System is part of Trinity Health, one of the largest multi-institutional Catholic health care delivery systems in the nation, serving communities in 21 states with 86 hospitals, 128 continuing care facilities and home health and hospice programs.
General Summary
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.
* 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
Performs other duties as assigned.
REQUIRED EDUCATION, EXPERIENCE AND CERTIFICATION/LICENSURE
Education:
High school diploma or an equivalent combination of education and experience. Associate degree in
Accounting or Business Administration highly desired.
Experience:
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.
Certification/Licensure:
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.
Why St. Joseph Mercy Health System?
* Competitive Salaries and Shift Differentials
* Rich Benefits package which include Medical, Dental, Vision, Paid Time off, Retirement Saving Plan with employer contribution option, Tuition Reimbursement, Life Insurance and Short/Long Term Disability.
* Opportunity for growth and advancement throughout Trinity Health in 21 different states
Visit www.stjoeshealth.org/careers to learn more about the benefits, culture and career development opportunities available to you at Saint Joseph Mercy Health System.
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.
