Senior Patient Access Specialist

Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy.

About the role

The Senior Patient Access Specialist is responsible for performing admitting duties for all patients admitted for services at the hospital. They are responsible for performing these functions while meeting the mission and goals of the organization and all regulatory compliance requirements. The Representative will work within the policies and processes as they are being performed across the entire organization.

• Assign accurate MRNs, complete medical necessity/compliance checks, provide proper patient instructions, collect insurance information, receive and process physician orders, and utilize an overlay tool while providing excellent customer service as measured by Press Ganey.
• Operate the telephone switchboard to relay incoming, outgoing, and inter-office calls as applicable, adhering to policies and providing excellent customer service.
• Be accountable for point-of-service goals as assigned.
• Utilize quality auditing and reporting systems to ensure accounts are corrected, including accounts for other employees, departments, and facilities.
• Conduct audits of accounts to ensure all forms are completed accurately and timely to meet audit standards, and provide statistical data to Patient Access leadership.
• Pre-register patient accounts prior to patient visits, including inbound and outbound calling to obtain demographic, insurance, and other patient information, including patient financial liabilities, point-of-service collections, past due balances, and payment plan options.
• Explain general consent for treatment forms to the patient/guarantor/legal guardian, obtain necessary signatures, and witness names.
• Explain and distribute patient education documents, such as Important Message from Medicare, Important Message from Tricare, Observation Forms, MOON form, Consent forms, and all forms implemented for future services.
• Review eligibility responses in the insurance verification system, select the applicable insurance plan code, and enter benefit data into the system to support POS (Point of Service Collections) and billing processes to assist with a clean claim rate.
• Accurately screen medical necessity using the Advanced Beneficiary Notice (ABN) software to inform Medicare patients of possible non-payment of tests by Medicare and distribute the ABN as appropriate.
• Distribute and document other designated forms and pamphlets.

Requirements

• Certified Healthcare Access Associate (CHAA) and/or CRCR, Certified Revenue Cycle Representative (Company Paid).
• 2-3 years of experience in patient access or a leadership role.
• Understanding of Revenue Cycle including admission, billing, payments, and denials.
• Comprehensive knowledge of patient insurance processes for obtaining authorizations and benefits verification.
• Knowledge of Health Insurance requirements.
• Knowledge of medical terminology, CPT, or procedure codes.
• Must be inquisitive and demonstrate openness to innovation, including AI, to explore better processes and ways to alleviate friction and improve patient and client experiences.

Preferred: 2-year/Associate Degree in Healthcare administration, business administration, or related field.

Benefits

• Bonus Incentives
• Paid Certifications
• Tuition Reimbursement
• Comprehensive Benefits
• Career Advancement
• Associate Benefits – Comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
• Culture – A place where associates can do their best work and be their best selves, rooted in collaboration, growth, and innovation.
• Growth – Investment in professional development, including earning a professional certification relevant to your field and tuition reimbursement.
• Recognition – Quarterly and annual incentive programs for employees who go beyond and raise the bar.

Pay

$18.65 - $19.90/hr. based on experience.

Schedule

This position is an onsite role at Mercy - St Rita's Medical Center in Lima, OH.

Ensemble is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information, or any other basis protected by applicable federal, state, or local laws. Ensemble provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law.