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Patient Access Specialist III
2 months ago
Position Overview:
CommonSpirit Health is a prominent entity in the healthcare sector, recognized for its commitment to delivering exceptional patient care and advancing medical research. Our facilities are designed with the patient experience in mind, utilizing evidence-based practices to ensure the safety and well-being of all individuals involved. Our collaborative efforts with leading medical institutions enable us to provide a comprehensive network of care that is unparalleled in the industry.
Key Responsibilities:
As a Patient Access Representative III, your primary role will be to facilitate access to the various services offered at our healthcare facilities. This includes:
- Gathering detailed information regarding patient insurance benefits.
- Engaging with patients and their families to discuss financial matters and insurance coverage during the initial evaluation.
- Providing guidance on billing issues and financial options available to patients.
- Coordinating necessary authorizations with payers to ensure compliance.
- Maintaining accurate and up-to-date records concerning insurance data, physician information, and managed care contracts.
- Assisting patients and their families with inquiries related to insurance and financial concerns.
- Identifying potential out-of-pocket expenses and effectively communicating this information to relevant parties.
- Collaborating with patients and families to explore alternative funding options when insurance coverage gaps are identified.
- Resolving patient billing issues in a timely manner.
- Ensuring accurate listing of payers for patients with multiple insurance plans.
- Processing patient accounts according to established policies to address insurance-related challenges.
- Initiating pre-certification for in-house patients as necessary, including obtaining relevant reference numbers and contact information.
- Notifying case managers of any changes in insurance plans for in-house patients.
- Communicating with physicians regarding authorization requirements for scheduled patients.
- Analyzing reports to ensure accuracy in patient admission data.
- Maintaining current knowledge of insurance companies and pre-certification requirements to stay informed of industry changes.
- Potentially serving as a team lead to ensure the smooth operation of daily activities, including assisting with scheduling and quality assurance.
Qualifications:
Education and Experience:
- High School Diploma or GED.
- A minimum of two (2) years of relevant experience in a healthcare setting.
Knowledge, Skills, and Abilities:
- Comprehensive understanding of various insurance plans, including HMOs, PPOs, and governmental payers.
- In-depth knowledge of HIPAA regulations and EMTALA compliance.
Note: The responsibilities outlined above are intended to provide a general overview of the role and may not encompass all tasks assigned to employees in this position. Employees may be required to perform additional duties as necessary.
