Patient Access Specialist - Part Time - Night

About the role

At Hackensack Meridian Health, Patient Access Specialists are responsible for all Inpatient and Outpatient Patient Access functions within the Patient Access Services Department in their assigned area/hospital(s). They conduct quality interviews with every patient to ensure compliance with patient safety rules and state and federal regulations, gather appropriate identification, confirm patient demographics, and screen Medicare, Medicaid, and managed care patients to identify network status and coordination of benefits. The role also involves obtaining patient consents/attestations, facility-based scheduling, bed planning, pre-registration, registration, insurance verification, pre-certification, point of service cash collection, and financial clearance under the direction of the Supervisor/Manager/Director. Adherence to Medical Center's Quality Standards and maintaining a positive patient experience are essential.

Responsibilities

• Greet patients and visitors in person or by phone in a prompt, courteous, respectful, and helpful manner.
• Implement scheduling, pre-registration, pre-certification, referral procurement, and insurance verification policies and procedures for assigned outpatient points of service.
• Adhere to patient identification policy and ensure accurate patient search to maintain patient safety and prevent duplicate medical record numbers.
• Check-in and account for the location and arrival/processing time of patients to ensure prompt service within established departmental time frames and guidelines.
• Ensure Regulatory Forms are filled out and signed by the patient.
• Perform all functions of bed planning; reservations/pre-registration/bed assignment, prioritizing bed assignment in accordance with policy.
• Ensure patients are assigned to the proper unit according to admit order and review orders to ensure patient is in appropriate status and level of care.
• Initiate real time eligibility query (RTE) on all eligible insurances and review RTE response to ensure correct plan code assignment and correct coordination of benefits.
• Ensure accurate completion of Medicare Secondary Payer Questionnaire.
• Perform insurance verification on all Inpatient and Outpatient services and determine the patient's out-of-pocket responsibility via the EPIC Financial Estimator tool.
• Pursue upfront cash collections to assist patients in understanding their financial responsibilities and minimize overall bad debt.
• Inform patients of their out-of-pocket responsibility, take payment via credit card or in person, and explain financial resources including financial assistance, payment plans, or payment on date of service.
• Verify benefits to ensure the procedure is a covered service under the patient's plan prior to receiving services.
• Verify pre-authorization requirements and follow up with both the referring physician and payer to ensure authorizations are on file for the scheduled procedure prior to date of service.
• Submit all data timely and expeditiously for all treatments and procedures to ensure authorizations have been obtained and the procedure or treatment is authorized prior to date of service.
• Ensure diagnosis data entered on registration is accurate and meets medical necessity criteria.
• Comply with HMH's patient financial responsibility and collection policies.
• Provide patients with appropriate administrative information as directed.
• Maintain compliance with federal/state requirements and ensure signatures are obtained on all required regulatory/consent forms.
• Manually register patients accurately during system downtime and follow registration input procedures when the system becomes available.
• Attempt to mediate daily scheduling, pre-registration, pre-certification, or registration issues and elevate any issues that cannot be resolved independently.
• Complete assigned work queue (WQ) accounts in a timely and efficient manner.
• Assume other responsibilities as directed by the Supervisor, Manager, or Director of Patient Access.
• Identify the needs of the patient population served and modify and deliver care specific to those needs (e.g., age, culture, language, hearing and/or visually impaired). Communicate with the patient, parent, and/or primary caregiver(s) at their level.
• Ensure delivery of excellent customer service resulting in a positive patient experience.
• Comply with all procedural workflows and departmental policies and procedures as identified.
• Responsible for scanning any documents and correspondence from patients and payers.
• Coordinate daily activities of the Patient Access Department to foster an environment promoting patient comfort and trust.
• Schedule patients as needed, answer a high volume of phone calls, and respond in an appropriate/professional manner.
• Address and resolve any issues quickly and accurately.
• Ensure timely notification of admission to payers and refer accounts to Case Management for timely submission of Clinical Information to payer.
• Verify eligibility and benefits to ensure patient's coverage is active and that the procedure is a covered service under the patient's plan prior to the date of service.
• Verify pre-authorization requirements and follow 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.
• Access and navigate various payer websites (e.g., Navinet) to confirm patients' insurance coverage and policy benefits.
• Work with patients to financially clear their account per policy at least 3 days prior to procedure, resolve any issues with coverage, and escalate complications to supervisor/manager.
• Make referrals to Financial Counselors if appropriate.
• Accurately and timely process all methods of acceptable payments such as cash/check/money order/credit card transactions.
• Reconcile daily cash drawer or shift payment transactions, deposit daily cash/check, and provide patients with cash receipts and/or service estimates.
• Complete a pre-registration on all appropriate patients in Epic, clear a checklist in Epic, and set an account status to "Confirmed pre-reg."
• Contact patients and/or physicians' offices regarding Pre-Admission Testing scheduling in a timely and efficient manner.
• Obtain patient records, type and process scheduling information, including copying, filing, faxing, and answering phone calls in an accurate, efficient, and professional manner.
• Work in all Access Services areas within the hospital and may rotate shifts as needed.
• Check email daily to maintain timely updates on any process/task changes/updates.
• Meet departmental daily productivity and process standards.
• Assume other duties and/or projects as assigned.
• Adhere to HMH Organizational competencies and standards of behavior.

Qualifications

Required

• 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.

Preferred

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

Licenses and Certifications

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

Pay

Minimum rate of $25.77 hourly.