Patient Access Specialist I
Company: Memorial Health
Posted on: October 14, 2021
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. Provides Mammography
Screening scheduling services to patients. Work may be performed in
a patient care area. Serves as a liaison between ancillary
departments and other Patient Access Services areas.
High School diploma required.
Must successfully complete assigned annual education through
Healthcare Business Insights.
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
- 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
- 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
- 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 10 CM) coding, and hospital billing claims
preferred, but not required.
- 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
- Schedules patients for Mammography procedures efficiently,
effectively, and according to established protocol for modality,
location, facility capabilities, insurance requirements, type of
exam, patient preferences, and urgency.
- 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 SMH involvement.
- Coordinates with SMH 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
- 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
- Verifies medical necessity, and obtains appropriate signature
on Advance Beneficiary Notice of non-coverage (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
- 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, SMH, 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, SMH, 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 SMH 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
- Attendance at quarterly department meetings is mandatory unless
absence is approved by PAS management prior to the meeting
- Performs pre-registration functions as requested.
- Performs other related work as required or requested.
Keywords: Memorial Health, Springfield , Patient Access Specialist I, Other , Springfield, Illinois
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