Patient Access Specialist — Allen Hospital

Primary Function/General Purpose

The Spec Patient Access LOR is responsible for performing admitting duties for all patients admitted for services at Mercy Health. They are responsible for performing these functions while meeting the mission and goals of Mercy Health ministry and all regulatory compliance requirements. The Spec Patient Access will work within the policies and processes as they are being performed across the entire organization.

Essential Job Functions

• Assigns accurate MRNs, completes medical necessity/compliance checks, provides proper patient instructions, collects insurance information, receives, and processes physician orders, and utilizes an overlay tool while providing excellent customer service as measured by Press Ganey.
• Operates the telephone switchboard to relay incoming, outgoing, and inter-office calls as applicable. Adheres to Mercy Health policies and provides excellent customer service in these interactions with the appropriate level of compassion.
• Conducts audits of accounts and assures that all forms are completed accurately, timely to meet audit standards and provides statistical data to Patient Access leadership.
• Pre-registers patient accounts prior to patient visits. This may include inbound and outbound calling to obtain demographic, insurance, and other patient information including the patient financial liabilities including collecting point of service collections as well as past due balances including payment plan options.
• Explains general consent for treatment forms to the patient/guarantor/legal guardian, obtains necessary signatures and witness’s name. Explains and distributes patient education documents, such as Important Message from Medicare, Important Message from Tricare, Observation Forms, MOON form, Consent forms, and all forms implemented for future services.
• Reviews eligibility responses in insurance verification system and appropriately selects the applicable insurance plan code, enters benefit data into system to support POS (Point of Service Collections) and billing processes to assist with a clean claim rate.
• Accurately screens medical necessity using the Advanced Beneficiary Notice (ABN) software to inform Medicare patients of possible non-payment of test by Medicare and distribution of the ABN as appropriate. Distributes and documents other designated forms and pamphlets.
• Performs all other duties as assigned including answering the phones at applicable facilities.

Licensing/Certification

• CHAA (Certified Health Access Associate) – National Association of Healthcare Access Management, preferred

Work Experience

• 1-2 years of patient access experience highly preferred.

Education

• High School Diploma or GED – required
• 2 Year / Associates Degree – preferred
• Combination of post-secondary education and experience in lieu of a degree

Training

• Medical terminology or CPT or procedure codes - preferred

Skills

• Typing
• Patient Insurance
• Obtaining Insurance Authorizations
• Benefits Verification
• Financial Acumen
• Analyzing data or information
• Health Insurance Requirements
• Medical Terminology
• CPT or Procedure Codes
• Attention to detail
• Acceptance of authority
• Critical thinking
• Communication with family members/patients
• Teamwork
• Conflict resolution
• Active listening
• Relationship building