Patient Access Specialist

Position Summary

This position is responsible for reviewing, verifying, and filling in missing registration/insurance information on encounters received electronically. The role applies and/or corrects billing details based on insurance carrier requirements and established departmental and company policies and procedures.

Essential Duties And Responsibilities

• Manages multiple client accounts according to assigned volume and established productivity expectations.
• Routinely monitors and reports low volumes, missing dates of service, and encounters lacking required insurance or payer information.
• Uses the RICA coding application and AthenaIDX to update and correct demographic records based on hospital/client data, resolving demographic, insurance, and Patient Access–related errors, edits, and rejections.
• Conducts necessary verification checks and assigns accurate payer information to support timely billing and maintaining a minimum accuracy rate of 95% in accordance with departmental and company policies.
• Takes ownership of Level 2 escalations from the offshore team, identifies and resolves issues preventing claim submission, and provides feedback or trending observations to the PA & EDI Supervisor for follow-up.
• Processes work within 2 business days from the date the work became available; notifies supervisor when not on target.
• Completes daily production records accurately and on time.
• Communicates any deviations from established workflows and escalates issues that impact daily submission or month-end close.
• Consistently communicates with others with respect, kindness, and understanding; is honest and clear; treats sensitive information confidentially; is perceived as positive and demonstrates quality services.
• Collaborates with internal teams (Billing, Coding, Enrollment, EDI, Leadership) when clarification or cross-departmental support is required.
• Participates in ongoing training, updates, and process improvements, ensuring compliance with evolving payer guidelines and internal workflows.
• Performs other related duties as assigned.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Requirements

• Knowledge, Skills, & Abilities:
• Strong attention to detail and accuracy, with the ability to identify discrepancies in demographic and insurance information.
• Ability to interpret eligibility files and understand payer requirements, rules, and coverage limitations.
• Knowledge of insurance types, payer hierarchy, and coordination of benefits.
• Ability to work independently with minimal supervision, manage pressure, and meet established deadlines.
• Computer literacy and proficiency with Microsoft Office (Excel required).
• Excellent communication skills for collaboration with internal teams and external partners.
• Ability to prioritize work and manage competing tasks.
• Understanding of HIPAA and handling of Protected Health Information (PHI).
• Critical thinking and problem-solving abilities to identify root causes of errors and determine appropriate corrective actions.
• Education & Experience Requirements:
• Requires High School Graduate or GED.
• Minimum of one year in the healthcare industry.
• Experience with Athena IDX a plus.
• Preferred Insurance data entry / Medical Front office training and/or Certification.