Patient Access Specialist - Full Time - Day

About the role

Our team members are the heart of what makes us better. At Hackensack Meridian Health, we help our patients live better, healthier lives—and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community. Together, we keep getting better—advancing our mission to transform healthcare and serve as a leader of positive change.

The Patient Access Specialist is responsible for all Inpatient and Outpatient Patient Access functions within the Patient Access Services Department in their assigned area/hospital(s) at Hackensack Meridian Health (HMH). This role conducts quality interviews with every patient to ensure compliance with patient safety rules and state and federal regulations.

Responsibilities

• Greets patients and visitors in person/phone in a prompt, courteous, respectful and helpful manner.
• Implements the Medical Center's scheduling, pre-registration, pre-certification, referral procurement, and insurance verification policies and procedures for the assigned outpatient point of service.
• Adheres to patient identification policy and ensures an accurate patient search is performed to maintain patient safety and prevent duplicate medical record numbers.
• Checks-in and accounts for the location and arrival/processing time of patients to ensure prompt service within established departmental time frames and guidelines.
• Ensures regulatory forms are filled out and signed by the patient.
• Performs all functions of bed planning: reservations, pre-registration, and bed assignment. Prioritizes bed assignment in accordance with policy.
• Ensures patients are assigned to the proper unit according to admit order. Reviews orders to ensure the patient is in the appropriate status and level of care.
• Initiates real-time eligibility query (RTE) on all eligible insurances. Reviews RTE response to ensure correct plan code assignment and coordination of benefits to facilitate timely reimbursement.
• Ensures accurate completion of the Medicare Secondary Payer Questionnaire.
• Performs insurance verification on all Inpatient and Outpatient services and determines the patient's out-of-pocket responsibility via the EPIC Financial Estimator tool using applicable data.
• Pursues upfront cash collections to assist patients in understanding their financial responsibilities and minimize overall bad debt.
• Informs patients of their out-of-pocket responsibility, taking payment via credit card or in person, and explaining financial resources including financial assistance, payment plans, or payment on the date of service.
• Verifies benefits to ensure the procedure is a covered service under the patient's plan prior to receiving services.
• Verifies pre-authorization requirements and follows up with both the referring physician and payer to ensure authorizations are on file for the scheduled procedure prior to the date of service.
• Submits all data timely, effectively, and expeditiously for all treatments and procedures to ensure authorizations have been obtained and determine that the procedure or treatment is authorized prior to the date of service.
• Ensures diagnosis data entered on registration is accurate and meets medical necessity criteria.
• Complies with HMH's patient financial responsibility and collection policies.
• Provides patients with appropriate administrative information, as directed.
• Maintains compliance with federal/state requirements and ensures signatures are obtained on all required regulatory/consent forms.
• Manually registers patients accurately during 'downtime' mode and properly follows registration input procedures when the system becomes available.
• Mediates daily scheduling, pre-registration, pre-certification, or registration issues and escalates any issues that cannot be resolved independently.
• Completes assigned work queue (WQ) accounts in a timely and efficient manner.
• Assumes other responsibilities as directed by either the Supervisor, Manager, or Director of Patient Access.
• Identifies the needs of the patient population served and modifies and delivers care specific to those needs (e.g., age, culture, language, hearing and/or visually impaired).
• Ensures delivery of excellent customer service resulting in a positive patient experience.
• Complies with all procedural workflows and departmental policies and procedures as identified.
• Responsible for scanning any documents and correspondence from patients and payers.
• Coordinates daily activities of the Patient Access Department to foster an environment promoting patient comfort and trust.
• Schedules patients as needed.
• Answers a high volume of phone calls and responds in an appropriate/professional manner. Addresses and resolves any issues quickly and accurately.
• Ensures timely notification of admission to payers and refers accounts to Case Management for timely submission of clinical information to the payer.
• Verifies eligibility and benefits to ensure the patient's coverage is active and that the procedure is a covered service under the patient's plan prior to the date of service.
• Verifies pre-authorization requirements and follows up with both the referring physician's office and payer to ensure authorizations are on file for the scheduled procedure prior to the date of service.
• Able to access and navigate various payer websites (e.g., Navinet) to confirm patients' insurance coverage and policy benefits.
• Works with patients to financially clear their account per policy at least 3 days prior to the procedure. Resolves any issues with coverage and escalates any complications to supervisor/manager.
• Makes referrals to Financial Counselors if appropriate.
• Accurately and timely processes all methods of acceptable payments such as cash, check, money order, and credit card transactions.
• Reconciles daily cash drawer or shift payment transactions, deposits daily cash/check, and provides patients with cash receipts and/or service estimates.
• Completes a pre-registration on all appropriate patients in Epic. Able to clear a checklist in Epic and set an account status to 'Confirmed pre-reg.'
• Contacts patients and/or physicians' offices regarding Pre-Admission Testing scheduling in a timely and efficient manner.
• Obtains patient records, types, and processes scheduling information including but not limited to copying, filing, faxing, and answering phone calls in an accurate, efficient, and professional manner.
• Can work in all Access Services areas within the hospital and may rotate shifts as needed.
• Checks email daily to maintain timely updates on any process/task changes/updates.
• Meets departmental daily productivity and process standards.
• Adheres to HMH Organizational competencies and standards of behavior.

Requirements

• High School diploma, general equivalency diploma (GED), and/or GED equivalent programs.
• Ability to work rotating schedules/shifts based on needs.
• Good written and verbal communication skills.
• Customer service-oriented.
• Basic medical terminology knowledge.
• Proficient computer skills that may include but are not limited to Microsoft Office and/or Google Suite platforms.
• Ability to work every other weekend.
• Ability to work three (3) out of six (6) holidays.

Qualifications

• Bachelor's Degree and/or related experience (preferred).
• Minimum of 1+ years of experience in a hospital setting (preferred).
• Patient Financial services experience in a professional or hospital setting (preferred).
• Prior registration/insurance verification experience (preferred).
• Excellent analytical, written, and verbal communication, and interpersonal skills (preferred).
• Proficient medical terminology knowledge (preferred).
• Knowledge of insurance specifications, ICD10, and CPT4 codes (preferred).
• Bilingual (e.g., Spanish or Korean) (preferred).
• Experience with EPIC HB, Cadence, and Prelude (preferred).

Licenses and Certifications

• Successfully complete EPIC Cadence and Prelude training and pass the assessment that follows within 30 days after Network access is granted.

Pay

Starting at $23.46 hourly.

Benefits

In addition to our compensation for full-time and part-time (20+ hours/week) job positions, HMH offers a comprehensive benefits package, including:

• Health, dental, and vision insurance.
• Paid leave.
• Tuition reimbursement.
• Retirement benefits.
• Performance-based incentives, bonuses, or commissions (for eligible positions).
• Shift differentials for work performed on evening, night, or weekend shifts (for eligible positions).