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Patient Access Coordinator

2 months ago

Rockford, Illinois, United States Mercy Health Full time
Job Summary

We are seeking a highly skilled Patient Access Specialist to join our team at Mercy Health. As a Patient Access Specialist, you will play a critical role in ensuring that patients receive timely and accurate access to healthcare services.

Key Responsibilities
  • Pre-register patients and ensure that all necessary information is gathered to facilitate smooth and efficient access to care.
  • Initiate and obtain referrals/authorizations/pre-certifications in a timely and accurate manner.
  • Answer incoming external/internal telephone calls and schedule appointments accordingly.
  • Register new and returning patients via multiline phone lines and various Mercy systems/applications.
  • Initiate outbound calls to external providers, patients, and/or payers based on referrals entered into the system.
  • Ensure compliance with Access and Revenue Cycle related policies and procedures.
  • Manage waitlists, rescheduling/cancellation of appointments as necessary.
  • Complete accounts in assigned WQ's.
  • Manage patient-initiated scheduling requests through MyChart, Telehealth, or other self-scheduling applications.
  • Maintain a high level of professionalism and provide a quality patient experience.
  • Schedule appointments appropriately according to provider and clinic-based protocols.
  • Perform ancillary tasks by providing outreach to patients.
  • Answer questions about the organization and provide callers with information about the site they are scheduled for.
  • Able to articulate information in a manner that patients, guarantors, and family members understand.
  • Ensure compliance with reporting related to demographics and federal and state requirements.
  • Have in-depth knowledge of community-based, state, or federal government programs to provide assistance to patients who have limited or no ability to pay for their healthcare needs.
  • Serve as a liaison to clinical staff by maintaining good communication regarding any problems and/or resolutions to patient issues or access concerns.
  • Contact insurance companies or employer groups via phone, web portals, electronic applications, or other appropriate means to determine eligibility and benefits for necessary services.
  • Maintain current knowledge of payor payment provisions and regulations to ensure correct data is gathered and documented.
  • Provide financial information to patients, which includes patient financial obligations, estimated costs of services, billing practices, and establishing payment arrangements as necessary.
  • Collect co-pays, deductible, and other out-of-pocket expenses via phone and/or in person and ensure 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 resources for financial assistance programs.
  • 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 for all specialties and modalities across the system.
  • OPAM Pre-Registration process is a different. As they are scheduling the patients and have them on the phone, they are reviewing their personal information and also checking on their insurance, is it in network, and additional verification. Triaging it a bit further as an example IF it is a worker's compensation and then follow additional information.
  • Promoting digital access and patient engagement to get them to leverage the capabilities that exist. (example: EPIC)
  • OPAM looks at the patient holistically, including current visit needs and then understanding additional needs of the patient and schedule them with another department.
  • Broader view of schedules to ensure coordination occurs throughout the whole system rather than at one physical location.
  • Ensure that Medical necessity is met.
  • Utilization of waitlists for the system to ensure that we are accelerating patients accessing system.
  • Focuses on schedule optimization by different area bringing in consistencies to services from a system perspective.
  • Looking for throughput optimizations as they work with different areas to maximize scheduling efficiencies across the system.
  • Needs the ability to understand multiple specialties and modalities and have the ability to support all of them.
Requirements
  • High school diploma or equivalent required.
  • Two years of customer service experience preferred.
  • Two years of healthcare registration, scheduling, or physicians' office experience required.
Certification/Licensure

Certification related to health care revenue cycle (Epic, AAHAM, NAHAM, HMFA, etc.) or an equivalently designated certification approved by management within 1 year of hire.

Special Physical Demands

The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations.

Prolonged sitting

Manual dexterity needed to operate telephone and keyboard.