Patient Access Account Specialist II

Presbyterian Healthcare Services

1d • Onsite

About The Position

Under the direction of the Patient Access Supervisor, the Patient Access Account Specialist II provides all necessary functions to financially clear patient accounts for government and commercial accounts prior to the date of service. This role encompasses all financial clearance functions, including insurance verification, authorization, collection and documentation of patient demographics, benefit analysis, financial counseling, and pre-service collections. The Patient Access Account Specialist II is responsible for ensuring follow-up on authorizations for scheduled and Urgent/Emergent procedures and admissions until the date of service or discharge. A proficient knowledge of Medicare (CMS) guidelines, HIPAA, EMTALA, and CMS guidelines of MSPQ is essential. The specialist monitors work queues for financial clearance and missing authorizations to ensure a payment source is identified and secured, leading to a clean claim for billing. This position also acts as the Subject Matter Expert for Patient Access employees and for testing new or existing software. The Patient Access Account Specialist II is committed to providing the highest level of customer service to patients, ancillary departments, and payers when financially clearing accounts. They collaborate with ancillary departments to ensure scheduled and authorized procedures meet payer requirements and provide coverage to other areas and hospitals as needed to minimize overtime and prevent registration delays. Additionally, the specialist assists in shadowing Patient Access candidates and training new hires upon their completion of the Patient Access Academy.

Requirements

• High school diploma
• Previous completion and passing of Patient Access Advocate II and III Advancement test.
• Completion and passing of In-house Patient Access Account Specialist Certification test.
• A minimum of 3 years of work experiences in healthcare setting with 2 years of Patient Access and/or billing plus strong customer service background.
• Robust knowledge and understanding of insurance and financial processing of accounts.
• Extended knowledge of medical terminology and billing codes (DRG, ICD-10, CPT, HCPCS).
• Proficient in EPIC ADT system.
• Pass annual competency exam for all areas of responsibility.
• Requires general knowledge of the customer encounter process which may include scheduling, registration, contract requirements, financial guidelines, and coordination of benefits.
• Knowledge in Microsoft Office Products.
• Demonstrated strong keyboarding skills, ensuring efficient data entry and documentation.
• Pass EPIC proficiency test required with a 85% score at completion of the Epic Training class.

Nice To Haves

• Continued education preferred
• CHAA, CHAM or other industry equivalent certification preferred

Responsibilities

• Achieve exceptional patient experience for patients and patient families by using CARES, AIDET and EPE tools.
• Addresses and attempts to appropriately resolve complaints in the moment by using key words at key times and de-escalation processes.
• Ability to manage conflict and appropriately request the help of a supervisor when needed.
• Implement PROMISE and CARES behaviors in every encounter.
• Educates patients for whom they speak regarding insurance benefits and liabilities.
• Ensures accounts are financially cleared prior to date of service to alleviate patient concerns over hospital financial matters.
• Provides patients with financial options to ensure a payer source for visits.
• Performs the patient registration process.
• Manage the accurate collection of patient data which includes but is not limited to; Obtain/confirm and enter demographic and other financial and clinical information necessary for final clearance of scheduled and Urgent/Emergent patient accounts.
• Review Urgent/Emergent admission accounts for notification, financial clearance and authorization pre-discharge.
• Obtain missing insurance information, to include policy number, group number, date of birth, and insurance phone number if not already identified in account.
• Verify insurance for eligibility and benefits using online electronic verification system or by contacting payer directly.
• Review and process work queues related to Patient Access pre-visit or urgent/emergent admissions, per department guidelines.
• Review of accounts falling within the work queues to ensure the insurance information contains accurate policy ID#s, Group Name and Numbers, Subscriber information, Authorization numbers, as well as correct payer and Coordination of benefits prior to date of service.
• Accurately document actions taken in the system of record to drive effective follow-up and ensure an accurate audit trail.
• Maintain ongoing knowledge of authorization requirements and payer guidelines.
• Maintain a proficient knowledge of Medicare (CMS) guidelines as it relates to admissions and outpatient services.
• Ensuring compliance with admissions forms, benefit entitlement verification, and billing requirements.
• Ensure accurate completion of MSPQ prior to date of service.
• Daily focus on attaining productivity standards; recommend new approaches for enhancing performance and productivity when appropriate.
• Monitor and track Data Quality program to ensure errors are corrected prior to final bill and correct accounts as necessary.
• Maintain appropriate records, files, and timely and accurate documentation in the system of record.
• Work with ancillary departments to ensure coding, diagnosis and facility are authorization are in alignment.
• Work with payers to ensure authorization is in place; initiating the auth when appropriate.
• Coordinate efforts with Financial Advocates to secure payer source current and future visits.
• Monitor work queues to identify late add-on accounts and complete financial clearance procedures prior to services to avoid unauthorized procedures from being performed.
• Work with physician offices to resolve discrepancies in authorizations and scheduled procedures.
• Collects identified patient financial obligation amounts including residual balance if applicable.
• Collect liability from patient prior to visit or make arrangements for payment at time of service.
• Educate patients on financial assistance, charity or other programs that may be available.
• Refers as appropriate to on site Financial Advocate or to the Financial Advocacy Center.
• Ensure a payer source has been identified prior to services being rendered.
• Ensure authorization for correct procedure (CPT), facility, and date of service is obtained.
• Contact patients pre-visit to complete any information missing from the account to ensure accuracy prior to visit.
• Transparency with patients through communication of patient liabilities and authorization issue in a timely manner, allowing patients ability to make informed decisions.
• Educate patients and answer questions from patients on benefits, liabilities and financial options.
• Provide patient with way-finding for appointment at time of pre-registration.
• Perform AIDET when speaking to patient to alleviate anxiety and confusion.
• Cooperate fully in all risk management activities and investigations.
• Report promptly any suspected or potential violations to laws, regulations, procedures, policies, and practices, and cooperate in related investigation.
• Conduct all transactions in compliance with all company policies, procedures, standards, and practices.
• Demonstrate knowledge of all applicable compliance and legal requirements of the job based on the scope of practice of the position.
• Demonstrates CARES behaviors of Collaborate, be Accountable, Respect, Engage and Serve to all whom you encounter.
• Other duties as assigned.

Benefits

• All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
• Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being.
• Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

What This Job Offers

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