Patient Access Specialist

Job Summary

The Patient Access Specialist (PAS) is responsible for confirming patient demographic and insurance information to ensure accurate billing for services provided by Total Health Care (THC). This includes completing insurance verification (EVS) on all patients scheduled to be seen at any THC site or department, communicating co-pay or payment requirements, collecting payments, reconciling receipts, and facilitating patient enrollment into Medicaid, MCHP, or a Qualified Health Plan.

Essential Job Functions

• Completes insurance verification (EVS) on all patients scheduled to be seen at any THC site or department.
• Confirms and enters patient’s current insurance status in the Practice Management System (PMS) at the time of check-in.
• Communicates co-pay or payment requirements at time of service and collects payments, co-payments as well as deductibles at point of service and post receipts accordingly.
• Completes daily self-pay log for self-pay patients and obtains appropriate sign-off.
• Reconciles receipts and prepares point of service collections for bank deposit.
• Adheres to company procedures for keeping of cash secure.
• Confirms that THC is listed as the facility providing care for the patient and ensures that the specific THC Primary Care Provider is entered in the PMS.
• Confirms authorizations are secured for CESH and Substance Abuse departments for current and upcoming visits.
• Obtains secondary QMB cards for qualified patients.
• Completes Medicare Secondary Payer questionnaire for appropriate coordination of benefits.
• Affords assistance with meeting department goals and department KPIs measures while maintaining integrity.
• Follows up with patient to clarify benefits and correct coordination of benefit issues.
• Provides financial counseling and provides information about the Maryland Health Connection, including eligibility requirements for applicable federal premium subsidies and cost-sharing assistance.
• Facilitates enrollment into Medicaid, MCHP, or a Qualified Health Plan.
• Provides referrals to appropriate agencies including the Attorney General’s Health Education and Advocacy Unit (HEAU) and the Maryland Insurance Administration (MIA), for applicants and enrollees with grievances, complaints, questions or the need for other social services.
• Scans front and back of patients' insurance/identification cards so they can be uploaded to the EMR.
• Completes the primary care provider change form if provider information is not valid and submits it via secure fax and obtains fax confirmation receipt on the day of the visit.
• Assists patients with completion of the Intake/Consent forms and obtains all necessary signatures and documentation required by the patients' insurance plan.
• Determines the appropriate financial class and/or account type and correctly assigns primary and secondary insurance billing status when two insurance plans require coordination of benefits.
• Determines eligibility of patients for 30 day/6 month sliding fee scale.
• Maintains tracking of Department of Social Services vouchers and other third party/community payer documentation as well as medical form and submits to Revenue Cycle Manager for billing.

Minimum Education, Training And Experience Required

• High School diploma or equivalent (post High School education preferred).
• Two years hospital or physician practice patient registration, customer service, insurance verification, financial clearance, or billing and ICD-9 medical coding experience in a healthcare environment.
• Certification as a Certified Healthcare Access Associate (CHAA) (NAHAM) Required.

Knowledge, Skills And Abilities

• Knowledge of FQHC operations, operating principles, guidelines and bylaws.
• Excellent leadership, customer service, organizational and presentation skills as well as the ability to effectively communicate THC’s vision, and motivate others to achieve it organizationally, departmentally, and personally/professionally.
• Ability to communicate effectively (verbally and in writing).
• Ability to plan and organize work initiatives to successfully accomplish center/organizational goals and objectives.
• Ability to multi-task, prioritize and delegate as appropriate.
• Strong analytical, problem-solving and interpersonal skills.
• Ability to identify, develop and implement short/long-term strategic goals and objectives.
• Ability to develop and maintain customer relationships; influence, build credibility and trust.
• Ability to think critically as well as apply critical thinking skills.
• Ability to ensure and advocate for quality healthcare and services; and, lead and manage a diverse staff.