Patient Access Account Specialist I-ABQ POSITION CONTROL

Presbyterian Healthcare Services

7d • $16 - $26 • Onsite

About The Position

Under the direction of the Patient Access Supervisor, the Patient Access Account Specialist I performs basic financial-clearance functions for government and commercial patient accounts before the date of service. These functions include insurance verification, authorization, collection and documentation of patient demographics, benefit analysis, and pre-service collections. The specialist follows up on authorizations for scheduled and urgent/emergent procedures and admissions through the date of service or discharge, as applicable, and monitors work queues to help ensure a payment source is identified and secured and accounts are ready for billing.

The role requires basic knowledge of Medicare (CMS) guidelines and applicable Patient Access compliance requirements, including HIPAA, EMTALA, and CMS guidelines for MSPQ. The specialist serves as a resource to Patient Access employees and provides customer service to patients, ancillary departments, and payers while financially clearing accounts. The specialist works with ancillary departments and physician offices to help ensure scheduled and authorized procedures meet payer requirements, and may cover other areas and hospitals as needed to minimize overtime and prevent registration delays. The position is based at the Reverend Hugh Cooper Administrative Center in Albuquerque and is full time, non-exempt, with a Monday–Friday weekday schedule. The listed pay range is $16.38–$25.57.

Requirements

• High school diploma; continued education preferred.
• At least two years of work experience in a healthcare setting within Patient Access and/or billing, plus a strong customer-service background.
• Strong knowledge and understanding of insurance and financial account processing.
• Proficiency in the EPIC ADT system.
• General knowledge of the customer encounter process, which may include registration, contract requirements, and coordination of benefits.
• Knowledge of Microsoft Office products.
• Strong keyboarding skills for efficient data entry and documentation.
• Pass the EPIC proficiency test with a score of at least 85% upon completion of the Epic Training class.
• Pass the annual competency exam for all areas of responsibility.
• Candidates must be at least 18 years old at the time of hire.
• External and internal candidates outside Patient Access must pass Patient Academy with a score of at least 85%.
• Previous completion and passing of the Patient Access Advocate II and III Advancement test.

Nice To Haves

• Continued education beyond high school.
• CHAA, CHAM, or another industry-equivalent specialty certification.

Responsibilities

• Provide courteous, high-quality customer service to patients, families, ancillary departments, and payers, using CARES, AIDET, EPE, and PROMISE practices.
• Address and attempt to resolve complaints and conflicts appropriately, escalating to a supervisor when needed.
• Educate patients about insurance benefits, liabilities, financial options, and authorization issues; communicate liabilities in a timely manner and provide appointment way-finding when appropriate.
• Perform patient registration and collect, verify, enter, and update demographic, financial, clinical, and insurance information required for account clearance.
• Review urgent/emergent admission accounts for notification, financial clearance, and authorization before discharge.
• Verify insurance eligibility and benefits through electronic systems or direct payer contact; obtain missing insurance information as needed.
• Review and process Patient Access pre-visit and urgent/emergent work queues according to department guidelines.
• Check account details—including policy and group information, subscriber details, authorization numbers, payer, and coordination of benefits—for accuracy before the date of service.
• Document actions accurately in the system of record and maintain timely records and files.
• Maintain knowledge of authorization requirements, payer guidelines, Medicare requirements, admissions forms, benefit-entitlement verification, and billing requirements.
• Complete the MSPQ accurately before the date of service.
• Meet productivity standards, recommend ways to improve performance and productivity, and monitor Data Quality items so errors are corrected before final billing.
• Coordinate with ancillary departments to align coding, diagnosis, facility, and authorization; work with payers to secure authorizations and initiate them when appropriate.
• Coordinate with Financial Advocates to secure payer sources for current and future visits.
• Identify late add-on accounts in work queues and complete financial clearance before services to help prevent unauthorized procedures.
• Work with physician offices to resolve discrepancies between authorizations and scheduled procedures.
• Collect patient financial obligations, including applicable residual balances, before the visit or arrange payment at the time of service.
• Ensure a payer source and authorization for the correct procedure, facility, and date of service are in place before services are rendered.
• Cooperate in risk-management activities and investigations, report suspected or potential violations, and conduct transactions in compliance with company policies and applicable legal requirements.
• Demonstrate CARES behaviors—Collaborate, be Accountable, Respect, Engage, and Serve—and perform other duties as assigned.

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• Short-term disability insurance
• Long-term disability insurance
• Group term life insurance
• Optional voluntary benefits
• Employee Wellness rewards program, with opportunities to earn gift cards through wellness activities

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED