Sr. 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.

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.
• Operate the telephone switchboard to relay incoming, outgoing, and inter-office calls as applicable.
• Utilize quality auditing and reporting systems to ensure accounts are corrected, including accounts for other employees, departments, and facilities.
• Develop training materials and programs for new hires to the department, as well as provide continuing education to associates in all areas of the revenue cycle.
• Develop staff schedules within the patient access department.
• Have 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.
• Collect point of service payments, including past due balances and offering payment plan options.
• Conduct audits of accounts and assure that all forms are completed accurately, timely to meet audit standards and provide statistical data to Patient Access Leadership.
• Explain general consent for treatment forms to the patient/guarantor/legal guardian, obtain necessary signatures and witness’s name.
• Distribute and document patient education documents, such as Important Message from Medicare, Observation Forms, Consent forms, and all forms implemented for future services.
• Review eligibility responses in insurance verification system and appropriately select the applicable insurance plan code, enter 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.
• 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

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
Desired Education Level: Associate degree or equivalent experience

Qualifications

Job Experience: 1 to 3 years in a similar role

Skills

Other Preferred Knowledge, Skills, and Abilities:

Benefits

Join An Award-winning Company
Five-time winner of “Best in KLAS” 2020-2022, 2024-2025 Black Book Research's Top Revenue Cycle Management Outsourcing Solution
2021-2024 22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle
2019-2024 Leader in Everest Group's RCM Operations PEAK Matrix Assessment
2024 Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance
2020, 2022-2023 Energage Top Workplaces USA
2022-2024 Fortune Media Best Workplaces in Healthcare
2024 Monster Top Workplace for Remote Work
2024 Great Place to Work certified
2023-2024 Innovation
Work-Life Flexibility
Leadership
Purpose + Values

Our Culture – Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.

Growth – We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.

Recognition – We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.

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 also prohibits harassment of applicants or employees based on any of these protected categories.

Ensemble provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law.