Patient Access Specialist
3 weeks ago
Overview:
Our team members are the heart of what makes us better.
At **Hackensack Meridian **_Health_** we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community.
Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.
The **Patient Access Specialist** is responsible for all Inpatient and Outpatient Patient Access functions within the Patient Access Services Department in their assigned area/hospital(s) at Hackensack Meridian _Health_ (HMH). Conducts quality interviews with every patient to ensure compliance with patient safety rules and state and federal regulations. Gathers appropriate identification for patients and confirms all patient demographics to validate patient identity. Conducts intensive screening of all Medicare, Medicaid and managed care patients to identify network status and coordination of benefits. Obtains all applicable patient consents/attestations. Performs job related functions including, but not limited to, facility based scheduling, bed planning, pre-registration, registration, insurance verification, pre-certification, point of service cash collection and financial clearance under the direction of the Supervisor/Manager/Director for these designated areas. Must adhere to the Medical Center's Quality Standards and maintain a positive patient experience at all times.
**Responsibilities**:
A day in the life of a** Patient Access Specialist** at Hackensack Meridian Health includes:
- Greets patients and visitors in person/phone in a prompt, courteous, respectful and helpful manner.
- Implements the Medical Center's scheduling, pre-registration, pre-certification, referral procurement and insurance verification policies and procedures for the assigned outpatient point of service.
- Adheres to patient identification policy and ensures an accurate patient search is performed in order to maintain patient safety and prevent duplicate medical record numbers.
- Check-in and account for the location and arrival/processing time of patients to ensure prompt service with the established departmental time frames and guidelines.
- Ensures Regulatory Forms are filled out and signed by the patient.
- Performs all functions of bed planning; reservations/pre-registration/bed assignment.
- Prioritizes bed assignment in accordance with policy.
- Ensures patients are assigned to the proper unit according to admit order.
- Reviews orders to ensure patient is in appropriate status and level of care.
- Initiate real time eligibility query (RTE) on all eligible insurances. Must review RTE response to ensure correct plan code assignment and correct coordination of benefits to facilitate timely reimbursement.
- Ensure accurate completion of Medicare Secondary Payer Questionnaire.
- Performs insurance verification on all Inpatient and Outpatient services, and determines the patient's out of pocket responsibility via the EPIC Financial Estimator tool using the applicable data.
- Where appropriate, pursues upfront cash collections to assist patients in understanding their financial responsibilities and minimize overall bad debt.
- Informs patients of their out of pocket responsibility taking payment via credit card or in person and explaining financial resources including financial assistance, payment plans or payment on date of service.
- Verifies benefits to ensure the procedure is a covered service under the patients plan prior to receiving services.
- Verifies pre-authorization requirements and follows up with both the referring physician and payer to ensure authorizations are on file for the scheduled procedure prior to date of service.
- Submits all data timely, effectively and expeditiously for all treatments and procedures to ensure authorizations have been obtained and determine that the procedure or treatment is authorized prior to date of service.
- Ensures diagnosis data that is entered on registration is accurate and meets medical necessity criteria.
- Complies with HMH's patient financial responsibility and collection policies.
- Provides patients with appropriate administrative information, as directed.
- Maintains compliance with federal/state requirements and ensures signatures are obtained on all required regulatory/consent forms.
- Manually registers patients accurately when in 'downtime' mode and properly follows registration input procedures when the system becomes available.
- Attempts to mediate daily scheduling, pre-registration, pre-certification or registration issues and elevates any issues that cannot be resolved independently.
- Completes assigned work queue (WQ) accounts in a timely and efficient manner.
- Assumes other responsibilities as directed by either the Supe
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