Patient Access Specialist

2 weeks ago

Rockford, United States Mercyhealth Full time

Overview:

- Patient Access Specialist, Days, Rockford, 80 Hrs / 2 wks
- Location: Rockton Ave Campus; Rockford, IL
- Hybrid and flexible work schedule opportunities available after probationary period.

Responsible for correctly prioritizing and completing all steps of the scheduling, referral management, authorization, verification and registration process prior to patients receiving services. Identifies scheduling needs, reviews schedules, follows scheduling protocols and enters visit information for appropriate scheduling. Identifies, verifies, and captures appropriate patient demographic information and health insurance benefit eligibility information. Performs payer coverage investigation, as necessary, utilizing both internal and external tools and resources, to obtain reimbursement verification. Utilizes knowledge including, but not limited to, managed care, commercial, government, and work comp insurance billing requirements, as well as current coding guidelines and standards, to ensure resolution of pre-service edits, appropriate management of claims, initiation and direction of accounts for pre-authorization as required, prevention of timely filing claim denials, and procurement of appropriate reimbursement. This position requires understanding of healthcare Revenue Cycle and the importance of evaluating and securing all appropriate financial resources to maximize reimbursement to the health system. This position assumes clinical and financial risk of the organization when collecting and documenting information on behalf of the patient.

**Responsibilities**:

- Ensures all scheduled visits are pre-registered and accounts are appropriately certified / authorized in advance of the service date.
- Initiates, obtains, and documents referrals/authorizations/pre-certifications in appropriate systems.
- Answers incoming external/internal telephone calls, determines purpose of calls and schedules appropriately or routes to physician practices or other departments as appropriate.
- Initiates outbound calls to external providers, patients, and/or payers based on referrals entered into the system and schedules appropriately. Communicates with provider’s office as needed.
- Ensures compliance with Access and Revenue Cycle related policies and procedures.
- Manages waitlists, rescheduling/cancellation of appointments as necessary.
- Completes accounts in assigned WQ’s.
- Maintains a high level of professionalism and provides a quality patient experience.
- Schedules appointments appropriately according to provider and clinic based protocols.
- Performs ancillary tasks by providing outreach to patients. Must have excellent customer service skills.
- Answers questions about organization and provides callers with address, directions and other information about the site that they are scheduled for.
- Able to articulate information in a manner that patients, guarantors, and family members understand.
- Ensures compliance with reporting related to demographics and federal and state requirements.
- Maintains current knowledge of payor payment provisions and regulations to ensure correct data is gathered and documented.
- Provides financial information to patients, which includes patient financial obligations, estimated costs of services, billing practices and establishing payment arrangements as necessary.
- Collects co-pays, deductible and other out of pocket expenses via phone and/or in person and ensures patients understand their financial obligation and arrange for payment at the time of visit.
- Must have a thorough understanding of patient payment options to be able to direct patients to appropriate resource for financial assistance programs. These programs may include Medicaid, Mercy Community Care and other community assistance as appropriate.
- Advises department leadership of possible postponement or deferral of any elective/non-emergent service which have not been approved prior to service date.
- Documents activity within appropriate EMR or patient accounting systems.
- Complies with Mercyhealth Cash Handling and Collection Policies.
- Demonstrates an understanding and follows patient confidentiality policies and all HIPAA Regulations.
- Performs other clerical duties as needed such as faxing, filing and photocopying.
- Subject matter expert with regards to assigned responsibilities.
- Provides training to new partners, as well as on an as-needed basis.
- Manages other duties as assigned.
- Completes pre-registration and ensures appropriate referrals are in place and authorized.
- Ensures compliance with Access and Revenue Cycle related policies and procedures.
- Reviews external orders/referrals to ensure authorization and compliance requirements are met.
- Assist with schedule utilization reports/documentation
- Participates in workgroups related to access/scheduling improvements.
- Notifies leadership of scheduling or access issues (time to next appt, provider cancellations, etc)
- OPAM schedules

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