Senior Patient Access Specialist

About the role

The Senior Patient Access Specialist is responsible for performing admitting duties for all patients receiving services at Ensemble Health Partners. Additional duties can include training, scheduling, and other senior-level responsibilities. They are responsible for performing these functions while meeting the mission of Ensemble Health Partners and all regulatory compliance requirements. The position pays between $18.65 - $19.90/hr based on experience.

Responsibilities

• Patient Access staff are responsible for assigning accurate MRNs, completing medical necessity or compliance checks, providing proper patient instructions, collecting insurance information, receiving, and processing physician orders while utilizing an overlay tool and providing excellent customer service as measured by Press Ganey.
• Serve as the SMART for the department, adhering to Ensemble Health Partners’ policies and providing excellent customer service in these interactions with the appropriate level of compassion.
• Operates the telephone switchboard to relay incoming, outgoing, and inter-office calls as applicable.
• Utilizes quality auditing and reporting systems to ensure accounts are corrected, including accounts for other employees, departments, and facilities.
• Develops training materials and programs for new hires to the department, as well as providing continuing education to associates in all areas of the revenue cycle.
• Develops staff schedules within the patient access department.
• Has on-call responsibilities for the department, including providing after-hours support and guidance. As part of on-call responsibilities, the Senior Patient Access Specialist may be responsible for working unscheduled times to cover staffing issues.
• Collects point of service payments, including past due balances and offering payment plan options.
• Conducts audits of accounts and assures that all forms are completed accurately, timely to meet audit standards and provides statistical data to Patient Access Leadership.
• Explains general consent for treatment forms to the patient/guarantor/legal guardian, obtains necessary signatures and witness’s name.
• Explains and distributes patient education documents, such as Important Message from Medicare, Observation Forms, Consent forms, and all forms implemented for future services.
• Reviews eligibility responses in insurance verification system and appropriately selects the applicable insurance plan code, enters benefit data into system to support POS (Point of Service Collections) and billing processes to assist with a clean claim rate including pre-registration of patient accounts prior to the patient visit which may include inbound and outbound calls to obtain demographic information, insurance information, and all other patient information.
• Responsible for accurately screening of medical necessity using the Advanced Beneficiary Notice (ABN) software to inform Medicare patients of possible non-payment of test by Medicare and distribution of the ABN as appropriate.
• Responsible for distribution and documentation of other designated forms and pamphlets.

Requirements

Understanding of Revenue Cycle including admission, billing, payments, and denials.
Comprehensive knowledge of patient insurance process for obtaining authorizations and benefits verification.
Knowledge of Health Insurance requirements.
Knowledge of medical terminology or 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.

Qualifications

• 1 to 3 Years of Experience
• Associate degree or Equivalent Education

Skills

Understanding of Revenue Cycle including admission, billing, payments, and denials.
Comprehensive knowledge of patient insurance process for obtaining authorizations and benefits verification.
Knowledge of Health Insurance requirements.
Knowledge of medical terminology or CPT or procedure codes.

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.

Pay

The position pays between $18.65 - $19.90/hr based on experience.

Schedule

Not specified.