Patient Access Specialist 1 WMCG

Job Summary

This job is typically the first point of contact and must ensure a pleasant experience for patients and visitors. It involves interviewing patients and/or their representatives to obtain complete and accurate demographic, financial and insurance information, required for billing and collecting patient accounts. It also includes conducting intensive screening of all Medicare, Medicaid and managed care patients for pre-certification requirements and provider service eligibility, prior to registration.

Core Responsibilities And Essential Functions

• Receives requests for reservations (patient scheduling) from physicians offices and makes the necessary pre-admission arrangements, referring to lists of dates allotted for scheduling, and advising physicians office staff of unavailable dates.
• Interviews each patient or representatives to obtain complete and accurate demographic, financial and insurance information.
• Enters all patient information into the registration system.
• Obtains all necessary signatures and is knowledgeable regarding any special forms that may be required by the patients third party payer.
• Reads physicians orders to determine the procedures requested and to instruct patients accordingly.
• Escorts or arranges to have patient escorted to procedure areas and assigned rooms.
• Makes corrections and updates patient account information in computer.
• Obtains new medical record numbers for newborn admissions and other new patients.
• Documents thorough explanatory notes on patient accounts, concerning any non-routine circumstances, clarifying special billing processes.
• Maintains a working knowledge of available information system capabilities and performs all system applications that are required.
• Understands and applies WHS philosophy and objectives, and PAS policies and procedures, as related to assigned duties.
• Maintains confidentiality of patient information, in accordance with WHS policy and HIPPA regulations.
• Consistently demonstrates the ability to organize work, recognizes and establishes appropriate work priorities, and completes work in a productive manner, without creating backlogs.
• Maintains proficiency in data entry skills.
• Aids physicians and their office staff to expedite scheduling, pre-admission, Medicaid screening and pre-certifications on all accounts.
• Solves error and applicable Claim, DNB, and Patient Work Queues.

Customer Service

• Greets all guests with a positive and professional attitude.
• Receives patients valuables for safekeeping in the hospital safe.
• Answers incoming phone calls and follows through with requests made.
• Maintains courteous and cooperative working relationships with WHS management, patients, physicians, other professional contacts, and the general public.
• Demonstrates ability to tactfully handle difficult situations.
• Presents a well-groomed and professional image in coordination with dept/ hospital dress codes.

Budget/Financial

• Tries to collect the estimated self-pay balance of all inpatient, outpatient and ER accounts, at the earliest possible collection control point.
• Maintains a list of health care financial assistance programs and the eligibility requirements for each program.
• Refers patients/guarantors to sources of outside funding assistance, as needed.
• Works efficiently and accurately within designated time frames to ensure a continuity of information and cash flow.
• Contacts scheduled patients at home to obtain pre-admission information, explain financial policies, estimate self-pay balances, and obtain a promise to pay on or before admission/registration.
• Interviews all inpatients and select (self-pay) outpatients at time of registration, or at least within 24 hours of admission, to verify complete insurance and financial information, explain financial policies, and collect the estimated self-pay balance.
• Documents concise and understandable notes regarding all self-pay account collection activity, as well as each patient or guarantor interaction.
• Documents all efforts to collect patient account balances, other self-pay collection activities and referrals to Medicaid.
• Coordinates financial counseling activities with Admitting, Outpatient Registration, Emergency Registration, Utilization Review, Nursing, Social Services, and Patient Financial Services.
• Verifies insurance coverage and benefits.
• Exceeds monthly quota on a consistent basis.
• Formally reports results of self-pay collection activity to direct supervisor, on a daily basis or according to policy.
• Provides feedback to PAS management concerning self-pay collection and data integrity issues.
• Identifies and resolves Payor Denials as indicated.

Required Minimum Education

High School Diploma

Other or GED

Other or Associates General-Preferred

Required Minimum License(s) And Certification(s)

All certifications are required upon hire unless otherwise stated. Additional License(s) And Certification(s) Required Minimum Experience: Minimum 1 year in healthcare, or institutional (corporate) work setting

Required Minimum Skills

• Computer/data entry experience.
• Ability to communicate with various members of the healthcare team.
• Effective communication skills (both written and verbal), attention to detail, self-directed and a positive attitude are essential.
• Effective problem solving and critical thinking skills.
• Working knowledge of patient registration systems and intermediate Microsoft Office Suite are preferred.
• Epic Experience Preferred.