Patient Access Specialist
2 weeks ago
We are seeking a highly skilled Patient Access Specialist to join our team at Hackensack Meridian Health. As a Patient Access Specialist, you will be responsible for ensuring the smooth and efficient flow of patients through our healthcare system. This includes conducting quality interviews with patients, gathering identification and demographic information, and verifying insurance coverage and benefits.
Key Responsibilities- Conduct quality interviews with patients to ensure compliance with patient safety rules and state and federal regulations.
- Gather identification and demographic information for patients and verify insurance coverage and benefits.
- Implement the Medical Center's scheduling, pre-registration, pre-certification, referral procurement, and insurance verification policies and procedures.
- Adhere to patient identification policy and ensure accurate patient search 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 within established departmental time frames and guidelines.
- Ensure regulatory forms are filled out and signed by patients.
- Perform all functions of bed planning, reservations, pre-registration, and bed assignment.
- Prioritize bed assignment in accordance with policy and ensure patients are assigned to the proper unit according to admit order.
- Review orders to ensure patient is in appropriate status and level of care.
- Initiate real-time eligibility query (RTE) on all eligible insurances and review RTE response to ensure correct plan code assignment and coordination of benefits.
- Ensure accurate completion of Medicare Secondary Payer Questionnaire.
- Perform insurance verification on all inpatient and outpatient services and determine patient's out-of-pocket responsibility via the EPIC Financial Estimator tool.
- Pursue upfront cash collections to assist patients in understanding their financial responsibilities and minimize overall bad debt.
- Inform patients of their out-of-pocket responsibility and take payment via credit card or in person, explaining financial resources including financial assistance, payment plans, or payment on date of service.
- Verify benefits to ensure procedure is a covered service under patient's plan prior to receiving services.
- Verify pre-authorization requirements and follow up with both the referring physician's office and payer to ensure authorizations are on file for the scheduled procedure prior to date of service.
- Submit 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.
- Ensure diagnosis data entered on registration is accurate and meets medical necessity criteria.
- Comply with HMH's patient financial responsibility and collection policies.
- Provide patients with administrative information as directed.
- Maintain compliance with federal/state requirements and ensure signatures are obtained on all required regulatory/consent forms.
- Manually register patients accurately when in 'downtime' mode and properly follow registration input procedures when the system becomes available.
- Attempt to mediate daily scheduling, pre-registration, pre-certification, or registration issues and elevate any issues that cannot be resolved independently.
- Complete assigned work queue (WQ) accounts in a timely and efficient manner.
- Assume other responsibilities as directed by the Supervisor, Manager, or Director of Patient Access.
- Identify the needs of the patient population served and modify and deliver care that is specific to those needs.
- Ensure delivery of excellent customer service resulting in a positive patient experience.
- Comply with all procedural workflows and departmental policies and procedures as identified.
- Responsible for scanning any documents and correspondence from patients and payers.
- Coordinate daily activities of the Patient Access Department to foster an environment promoting patient comfort and trust.
- Have the ability to schedule patients as needed.
- Answer a high volume of phone calls and respond in an appropriate/professional manner, addressing and resolving any issues quickly/accurately.
- Ensure timely notification of admission to payers and refer accounts to Case Management for timely submission of Clinical Information to payer.
- Verify eligibility and benefits to ensure patient's coverage is active and that the procedure is a covered service under the patient's plan prior to the date of service.
- Verify pre-authorization requirements and follow up with both the referring physician's office and payer to ensure authorizations are on file for the scheduled procedure prior to the date of service.
- Able to access and navigate various payer websites (e.g. Navinet) to confirm patients' insurance coverage and policy benefits.
- Work with patients to financially clear their account per policy at least 3 days prior to procedure, resolving any issues with coverage and escalating any complications to supervisor/manager.
- Accurate and timely processing of all methods of acceptable payments such as cash/check/money order/credit card transactions, reconciling daily cash drawer or shift payment transactions, depositing daily cash/check, and providing patients with cash receipts, and/or service estimate.
- Complete a pre-registration on all appropriate patients in Epic, able to clear a checklist in Epic, and set an account status to 'Confirmed pre-reg.'
- Contact patients and/or physicians' offices in regards to Pre-Admission Testing scheduling in a timely and efficient manner.
- Obtain patient records, type, and process scheduling information, including but not limited to copying, filing, faxing, and answering phone calls in an accurate, efficient, and professional manner.
- Can work in all Access Services areas within the hospital and may rotate shifts as needed.
- Check email daily to maintain timely updates on any process/task changes/updates.
- Meet departmental daily productivity and process standards.
- Other duties and/or projects as assigned.
- Adhere to HMH Organizational competencies and standards of behavior.
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