Patient Access Specialist
Company: Memorial Health
Location: Springfield
Posted on: January 12, 2021
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Job Description:
Overview Hours: 9:45pm-6:15am Assists in providing access to
services provided at the hospital and/or other service area.
Processes registration information for the patient visit, obtaining
patient demographic and third party information with a high degree
of accuracy, and performs financial collections. Performs the
timely completion, preparation, and deployment of legal, ethical
and compliance related documents that must be presented and
thoroughly explained to the patient at the time of registration.
Maintains knowledge of JCAHO, Patient Rights and Responsibilities,
HIPAA, HMOs, Commercial Payers, and departmental / system policies
and procedures. Work may be performed in a patient care area.
Serves as a liaison between ancillary departments and other Patient
Access Services areas. Qualifications Education: * High School
diploma or equivalent required. Experience: * One (1) years of
business office experience, preferably in the areas of Patient
Access, billing, collections, insurance principles/practices, or
accounts receivable. * Completion of 12 (twelve) hours of
coursework in a business or healthcare related field of study may
be considered in lieu of business office experience. * Previous
experience in Patient Access is highly desirable. Other
Knowledge/Skills/Abilities: * Knowledge of all tasks performed in
the various Patient Access Service areas is necessary to provide
optimum internal and external customer satisfaction and provide the
opportunity for accurate reimbursement. * Demonstrates superior
patient relations and interpersonal skills; demonstrates an
appropriate level of mental and emotional tolerance and even
temperament when dealing with staff, patients and general public,
using tact, sensitivity and sound judgment; promotes a positive
work environment and contributes to the overall team efforts of the
department and organization. * Working knowledge of computers is
required, with the ability to enter and retrieve data, and
electronically notate registration software, and other required
applications/systems. * Must demonstrate detail orientation,
critical thinking, and problem solving ability. * Must demonstrate
excellent oral and written communication and customer service
skills, with ability to maintain a calm and professional demeanor
in high stress situations. * Demonstrated ability to remain
flexible, and consistently exercise sound judgment and initiative
in very stressful situations. * Ability to effectively manage
competing priorities and work independently in a rapidly changing
environment. * Must demonstrate ability to educate, persuade, and
negotiate effectively with patients and families. * Knowledge of
medical terminology, medical procedural (CPT) and diagnosis (ICD-9
CM) coding, and hospital billing claims preferred, but not
required.Responsibilities * Completes all steps of
pre-registration/registration; verifies patient identity and
demographic information through appropriate tools.
Identifies/captures appropriate health insurance benefit
eligibility based on contract/regulatory differentiation.
Facilitates appropriate billing of claims and hospital
reimbursement. Obtains and validates proper consent for patient
treatment. * Educates patients/others regarding the resolution of
billing, private pay options, collection efforts, coordination of
benefits, third party and governmental payment criteria, insurance
coverage, payments, and denials. May serve as a liaison between
external resources and patients on issues requiring MMC
involvement. * Coordinates with MMC Patient Financial Services,
Utilization Management, physicians, and medical offices to ensure
consistent financial documentation across the enterprise, and an
interdisciplinary approach to patient and organizational needs. *
Adheres to all CMS Conditions of Participation regulations and
Section 1154(e) of the Social Security Act regarding delivery,
explanation, and acquisition of patient/designated representative
signatures . * Verifies medical necessity, and obtains appropriate
signature on Advance Beneficiary Notice of Noncoverage (ABN) per
CMS regulations at points of patient access. * Negotiates with
patients and families to collect patient co-pays and/or deposits at
point of service. Supports Patient Access Services POS (Point of
Service) collection goals as defined by Revenue Cycle leadership
and best practice benchmarks. * Triages, documents, and initiates
referrals of patients to Medicaid vendor and/or for financial
assistance, per the Illinois Fair Patient Billing Act, Illinois
Uninsured Patient Discount Act, and established MMC procedures. *
Identifies/reviews services requiring
pre-authorization/pre-certification by Medicare, Medicaid,
Commercial, and Managed Care payers, to ensure provider eligibility
requirements are met prior to receiving service. Utilizes
appropriate technology and/or communicates with physician offices.
* Analyzes reports containing rejected accounts from a variety of
hospital sources, including Non-Patient Access registration
departments, and resolves toward verification of patient benefit
eligibility, and subsequent reimbursement from all possible payer
sources, or determines suitability for financial assistance. *
Orients and cross-trains others within assigned area of
responsibility as directed and defined by management. May assist
other areas within the unit or department, as necessary, during
times of special needs or staff absences. May be required to work
night or weekend shifts. * Ensures compliance with all applicable
HIPAA, Joint Commission, CDC, MMC, and state and federal statues,
providing required associated literature to patients at all PAS
access points. Educates patients regarding Advance Directives,
Medicare D prescription coverage, MMC, Joint Commission, and
Illinois Department of Public Health grievance process as
appropriate. * Maintains current knowledge of, and complies with,
the Illinois Fair Patient Billing Act and Illinois Uninsured
Patient Discount Act at all times. * Completes Illinois DHS legal
forms for psychiatric admits, in compliance with State of Illinois
and MMC statues and guidelines. Provides relevant patient/family
education * May rotate work settings, i.e., patient registration,
bedside registration, or other MMC campus environments. May be
required to provide coverage for the MMC Financial Lobby Office. *
Develops and maintains a comprehensive knowledge of the health
system organization and its functions. Completes all assigned
annual organizational education * Meets expectations for
productivity, accuracy, and point of service collections. *
Attendance at quarterly department meetings is mandatory unless
absence is approved by PAS management prior to the meeting
date.
Keywords: Memorial Health, Springfield , Patient Access Specialist, Other , Springfield, Illinois
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