Patient Access Specialist

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.

Requirements

• 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.