Patient Access Associate III - Central Financial Clearance - 40hrs

About the Role

Under limited supervision, independently coordinates and performs multiple complex functions within the Patient Access department. Utilizes considerable judgment in interpreting departmental policies to resolve routine to complex inquiries or patient account problems. Identifies opportunities for process improvements, offers potential solutions, and implements them. Participates in meetings as a representative of the department. Serves as the primary resource to team members for training, problem resolution, etc. Performs all duties in a manner that promotes a team concept and reflects the mission, behaviors, core values, and philosophy of CT Children’s Medical Center.

Responsibilities

• Administrative:
  • Provides general receptionist, secretarial support, or Health Unit Coordinator functions following department protocol.
  • Performs a variety of administrative support activities in support of unit operations.
  • Responds with tact and discretion to the needs of patients and families while maintaining privacy and confidentiality (HIPAA).
  • Independently creates staffing assignments, scheduling, and delegation of tasks or work assignments.
  • Provides training and quality assurance to new and current staff members.
  • Identifies trends in process opportunities and provides educational training to team members for improvement.
  • Deals compassionately and professionally with patients and families as a first-line representative of CT Children’s.
• Quality Assurance & Training:
  • Audits Complete Registration data, including documentation records for incomplete information, patient or guarantor interactions, co-payment collection efforts, estimated self-pay balances, and referrals to Medicaid.
  • Ensures all outstanding issues are resolved in a timely manner and identifies trends for follow-up training.
  • Provides weekly reviews for new employees and at least monthly reviews for current employees.
  • Ensures employees close drawers in a timely fashion per standard process.
  • Creates and maintains spreadsheets and databases.
  • Acts as a liaison with the patient accounting department for denials and account problem resolution.
• Registration:
  • Collects and enters accurate demographic, guarantor, and financial data for Emergency Department, Inpatient, Outpatient, and Physician Practice Office appointments.
  • Verifies all required insurance and billing information and uses proper payer plan codes.
  • Generates necessary forms for patient visits and obtains patient/parent/legal guardian signatures for Assignment/Authorization and consent.
  • Performs pre-registration for scheduled patients and registers patients adhering to standard department procedures.
  • Makes corrections and updates patient information in ADT systems as necessary.
  • Asks patients/families about visit satisfaction and addresses any questions/issues prior to departure.
  • Attempts to collect patient liability and co-payments at the designated collection point.
  • Documents thorough, clear notes regarding incomplete information, insurance verification, patient interactions, and collection efforts.
  • Follows up on open items to resolve outstanding issues and completes files.
  • Reviews and works assigned work queues to ensure account accuracy at the time of visit or billing.
  • Creates a feedback loop to front-end users regarding correct and complete registration.
• Scheduling:
  • Schedules routine and complex appointments in person or via telephone.
  • Creates/inputs routine and complex department provider appointments.
  • May schedule/coordinate appointments with other areas of the hospital.
  • Builds and maintains scheduling templates.
  • Ensures all consent and privacy forms are signed.
  • Works directly with DCF to obtain appropriate signatures/legal guardian information.
• Front Office (Check-In):
  • Arrives patients for their appointment in the ADT system.
  • Verifies demographic and insurance information at time of arrival, including securing patient financial liability.
  • Enters routine to complex patient charges into the billing system for physician or care provider visits.
  • Independently performs check-out processes, including scheduling or rescheduling future appointments.
  • Answers telephone and triages calls for the department.
  • Ensures all consent and privacy forms are signed.
  • Works directly with DCF to obtain appropriate signatures/legal guardian information.
  • Performs other front office duties as required.
• Financial Clearance:
  • Responsible for various work queues of scheduled and/or non-scheduled appointments.
  • Communicates with insurance companies to obtain benefits, referrals, and/or authorization requirements.
  • Communicates with clinical/office staff regarding patient eligibility, authorization status, and need for clinical documentation.
  • Completes chart reviews to submit appropriate documentation to insurance companies for authorization purposes.
  • Coordinates with third-party payers regarding information necessary for appropriate financial processing of patients.
  • Follows up with primary care providers for referrals and authorizations, notifies insurance carriers of admissions, obtains authorizations, and verifies benefits eligibility.
  • Refers patients/families to Financial Counseling for updated and/or eligibility issues.
  • Works directly with RN, APRN, and MD level staff to notify of denials requiring further action.
  • Coordinates with Utilization Review for status designation of Outpatient/Inpatient Admissions.
  • Coordinates daily assignments and escalates clinic concerns to the management team regarding authorization barriers.
  • Works directly with Insurance Provider Representatives to resolve outstanding authorization issues.
  • Maintains abnormality tracking of outstanding issues causing delay and/or denial of authorization.
• Financial Counselor:
  • Responsible for various account review work queues.
  • Communicates with insurance companies to obtain insurance benefits.
  • Communicates with other departments regarding patient eligibility and financial application status.
  • Supports Financial Counselors with patient/family account inquiries.
  • Expert in EPIC billing system.
  • Interviews patients and/or families to verify complete insurance and financial information, explain financial policies, and complete appropriate financial evaluation forms.
  • Assists patients/families with DSS and Financial Assistance processes.
  • Determines guarantor’s propensity to pay non-covered charges and potential eligibility for financial assistance programs.
  • Establishes financial arrangements/payment plans with patients.
  • Identifies reasons for non-payment and follows up to ensure resolution.
• Financial Responsibility:
  • Verifies insurance plans using methods such as RTE, Web-Based, and Telecommunications.
  • Investigates patient insurance coverage, facilitates certification, and manages processes to maximize payment from commercial and managed care plans.
  • Follows up with team members responsible for patient accounts to resolve outstanding financial issues.
  • Demonstrates knowledge of age-related differences and needs of patients from neonate through adolescence.
  • Demonstrates cultural sensitivity in all interactions with patients/families.
  • Demonstrates support for the mission, values, and goals of the organization through behaviors consistent with CT Children’s STANDARDS.
• Supervisory Responsibilities:
  • May coordinate daily activities of the department, delegate assignments to staff, and serve as a primary resource.
  • Serves as a 1st-level resource to staff and leadership regarding daily processes and issues.
  • Active participant in at least one hospital committee; shares departmental and/or organizational initiatives with team members.

Requirements

• Education and/or Experience Required:
  • High School Diploma, GED, or a higher level of education that requires completion of high school.
  • Healthcare experience required.
• Education and/or Experience Preferred:
  • Bachelor’s or Associate’s Degree strongly preferred.
  • 2-4 years of directly related experience required; 1 year of CT Children’s direct related experience preferred.
• License and/or Certification Required:
  • CHAA (Certified Healthcare Access Associate) required within 1 year.

Skills

• Knowledge of:
  • Advanced MS Word and Excel.
  • ADT systems and Insurance Verification systems (EPIC preferred).
  • Managed Care, referral/pre-certification/authorization, denials, patient accounts, and DSS.
• Skills:
  • Computer, typing, and data entry.
  • Excellent verbal and written communication.
  • Excellent organizational skills.
  • Ability to provide feedback to staff.
• Ability to:
  • Handle a fast-paced, high-volume environment.
  • Work in a team environment alongside multiple disciplines.
  • Coordinate workflows, anticipate, and reassign/balance workloads.
  • Provide continued guidance and training to staff and delegate effectively.
  • Independently have crucial conversations with others/staff.

About Us

Connecticut Children’s is the only health system in Connecticut that is 100% dedicated to children. Established on a legacy that spans more than 100 years, Connecticut Children’s offers personalized medical care in more than 30 pediatric specialties across Connecticut and in two other states. Our transformational growth establishes us as a destination for specialized medicine and enables us to reach more children in locations closer to home. Our breakthrough research, superior education and training, innovative community partnerships, and commitment to diversity, equity, and inclusion provide a welcoming and inspiring environment for our patients, families, and team members. At Connecticut Children’s, treating children isn’t just our job – it’s our passion. As a leading children’s health system experiencing steady growth, we’re excited to expand our team with exceptional team members who share our vision of transforming children’s health and well-being as one team.