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Access Coordinator II
2 months ago
Job Overview
General Summary:
This position is responsible for executing various processes including scheduling, pre-registration, financial clearance, authorization, referral validation, and pre-serviceability estimations and collections within Patient Access. This role is crucial in creating a positive first impression of Highmark Health's services for patients, families, and external customers. The incumbent will communicate information clearly to ensure patients and their families understand what to expect and their financial obligations. This role carries clinical and financial responsibilities when gathering and documenting patient information. Additionally, the position involves training and supporting other team members as needed.
Key Responsibilities:
- Conducts scheduling and pre-registration tasks, verifies patient demographic information, identifies and confirms medical benefits, and ensures accurate plan codes and coordination of benefits. Gathers limited clinical data as necessary based on the required service. Updates and corrects all relevant data to ensure timely and accurate billing submissions. (20%)
- Confirms insurance details through payor contacts via phone, online resources, or electronic verification systems. Identifies payor authorization and referral requirements, providing necessary documentation and follow-up to physician offices, case management departments, and payors regarding any deficiencies. (20%)
- Assesses all patient financial responsibilities, calculates estimates, collects liabilities, and processes payment transactions appropriately in the ADT system while performing daily reconciliations. Recognizes self-pay and complex liability calculations, escalating accounts to Financial Counselors as necessary. (20%)
- Ensures a positive patient experience by fostering excellent working relationships with patients, Highmark Health leadership, staff, physician offices, and designated external agencies or vendors. Engages in written and verbal communication to exchange information with designated contacts and promote collaborative relationships. (10%)
- Maintains focus on achieving productivity standards and recommends innovative strategies for enhancing performance and productivity when appropriate. (10%)
- Adheres to Highmark Health organizational policies and procedures relevant to the location and job scope. Completes and/or participates in mandatory training and educational sessions within established organizational guidelines and timelines. (10%)
- Communicates any team barriers, process flow, or productivity issues to the team lead. Provides operational support and training to team members and assists in resolving patient issues that require additional oversight in a clear and informative manner as needed. (10%)
- Performs additional duties as assigned or required.
Qualifications:
Minimum Requirements:
- High school diploma or GED; or one to three months of related experience and/or training; or an equivalent combination of education and experience.
- Two years of related experience, preferably in a medical setting, financial services environment, or a demanding customer service role.
- Proficient in operating a PC and utilizing software applications.
Preferred Qualifications:
- Certification from the Healthcare Financial Management Association or as a Certified Revenue Cycle Representative.
- Experience in a call or service center environment.
Highmark Health and its affiliates are committed to ensuring equal employment opportunities for all individuals, prohibiting discrimination based on protected veteran status or disability, and ensuring fairness regardless of race, color, age, religion, sex, national origin, sexual orientation, gender identity, or any other category protected by applicable law.
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