Patient Access Specialist I

Key Responsibilities

• Collect and verify patient demographics, insurance information, and financial details.
• Ensure all registration data is accurate and complete, facilitating the patient’s timely access to services.
• Prepare and present legal, ethical, and compliance-related documents, ensuring patients understand and complete all required forms during registration.
• Maintain knowledge of JCAHO standards, Patient Rights and Responsibilities, HIPAA regulations, and payer requirements.
• Provide scheduling services for mammography screenings, following established protocols for insurance, exam type, patient preferences, and urgency.
• Act as a liaison between Patient Access Services and ancillary departments, facilitating communication and ensuring a smooth flow of information and services for patients.
• Perform financial collections, including co-pays and deposits at the point of service.
• Educate patients regarding billing, insurance coverage, and payment options.
• Adhere to CMS Conditions of Participation, obtaining necessary signatures (ABN, consent forms) as required by CMS regulations.
• Support patient care areas as needed, helping ensure timely and accurate documentation for patient services.

Position Details

Hours of Shift: 9:45pm-6:15am
Weekends: Every Other Weekend (9:45pm-6:15am)
FTE: 1.0

Qualifications

• High school diploma required.
• Licensure/Certification/Registry: Must successfully complete assigned annual education through Healthcare Business Insights.
• Experience: Minimum of one (1) year of business office experience, preferably in areas such as Patient Access, billing, collections, insurance principles/practices, or accounts receivable.
• Completion of 12 (twelve) hours of coursework in a business or healthcare-related field may be considered in lieu of business office experience.
• Previous experience in Patient Access is highly desirable.
• Knowledge, Skills, And Abilities:
• Comprehensive knowledge of tasks performed across various Patient Access Service areas to ensure customer satisfaction and accurate reimbursement.
• Excellent interpersonal and patient relations skills, with the ability to maintain emotional composure and exercise sound judgment in all interactions.
• Working knowledge of computers, including the ability to enter and retrieve data from registration software and other required applications/systems.
• Strong attention to detail, critical thinking, and problem-solving abilities.
• Excellent oral and written communication skills, with the ability to maintain professionalism in high-pressure situations.
• Flexibility and the ability to exercise judgment and initiative, especially in stressful or rapidly changing environments.
• Able to manage competing priorities independently and effectively.
• Strong negotiation and persuasion skills when educating and communicating with patients and families.
• Knowledge of medical terminology, medical procedural (CPT), and diagnosis (ICD-10 CM) coding, as well as hospital billing claims is preferred but not required.

Responsibilities

• Pre-Registration/Registration: Completes all steps of pre-registration/registration, verifies patient identity and demographic information, and captures health insurance benefit eligibility based on contract/regulatory requirements.
• Ensures proper consent for patient treatment is obtained.
• Mammography Scheduling: Schedules patients for Mammography procedures according to established protocols, ensuring proper modality, location, insurance requirements, patient preferences, and urgency.
• Billing and Payment Education: Educates patients on billing resolution, private pay options, collection efforts, coordination of benefits, third-party payments, insurance coverage, payments, and denials.
• Acts as a liaison between external resources and patients for issues requiring SMH involvement.
• Cross-Department Collaboration: Works with Patient Financial Services, Utilization Management, physicians, and medical offices to maintain consistent financial documentation and interdisciplinary collaboration.
• Regulatory Compliance: Adheres to CMS Conditions of Participation and Section 1154(e) of the Social Security Act, ensuring proper patient signature acquisition.
• Verifies medical necessity and obtains signatures on Advance Beneficiary Notice of non-coverage (ABN) per CMS regulations.
• Co-Pay and Deposit Collection: Negotiates with patients and families to collect co-pays and/or deposits at the point of service, supporting POS collection goals.
• Financial Assistance Referrals: Triage, document, and refer patients to Medicaid vendors or financial assistance per the Illinois Fair Patient Billing Act and SMH procedures.
• Pre-Authorization/Pre-Certification: Identifies services requiring pre-authorization and works with physicians to meet eligibility requirements prior to service.
• Account Rejection Resolution: Analyzes and resolves rejected accounts from various hospital sources, ensuring verification of patient benefit eligibility and reimbursement from all payer sources, or suitability for financial assistance.
• Staff Training and Coverage: Orients and cross-trains others within the department and provides coverage during staff absences or special needs.
• HIPAA and Regulatory Compliance: Ensures compliance with all HIPAA, Joint Commission, CDC, SMH, and state and federal regulations.
• Edits patients about Advance Directives, Medicare D coverage, and the grievance process as appropriate.
• Knowledge Maintenance: Maintains up-to-date knowledge of applicable regulations, including the Illinois Fair Patient Billing Act and Illinois Uninsured Patient Discount Act, and completes all required annual organizational education.
• Legal Forms Compliance: Completes Illinois DHS legal forms for psychiatric admits in compliance with state and hospital policies, providing relevant education to patients and families.
• Flexible Work Settings: May rotate between different work settings such as patient registration, bedside registration, or SMH campus environments, and provide coverage for the SMH Financial Lobby Office.
• Productivity and Accuracy: Meets expectations for productivity, accuracy, and point of service collections.
• Attends quarterly department meetings unless otherwise approved.
• Additional Duties: Performs other related work as assigned.