Patient Access Advocate I-ABQ

Presbyterian Healthcare Services

1d • $16 - $26 • Onsite

About The Position

The Patient Access Account Specialist I (PAAS I) performs basic financial-clearance functions for government and commercial patient accounts before the date of service. Under the direction of the Patient Access Supervisor, the role verifies insurance, obtains authorizations, collects and documents patient demographic and benefit information, and collects pre-service payments. The specialist follows up on authorizations for scheduled and urgent or emergent procedures and admissions through the date of service or discharge.

The PAAS I monitors financial-clearance and missing-authorization work queues to identify and secure a payment source and support clean claims. The position requires basic knowledge of Medicare (CMS) guidelines and applicable compliance requirements, including HIPAA, EMTALA, and CMS guidelines for MSPQ. The specialist works with patients, ancillary departments, physician offices, payers, and Financial Advocates to resolve account and authorization issues, and serves as a resource to Patient Access employees. The role also provides coverage to other areas and hospitals as needed to minimize overtime and prevent registration delays.

This is a full-time, non-exempt position based at Presbyterian Healthplex in Albuquerque, with a Friday-through-Sunday work schedule. The position emphasizes exceptional patient service, accurate financial and clinical documentation, compliance, and timely financial clearance.

Requirements

• High school diploma; continued education preferred.
• At least 2 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 processing of accounts.
• 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 85% upon completion of the Epic Training class.
• Pass the annual competency exam for all areas of responsibility.
• Be at least 18 years of age at the time of hire.
• External and internal candidates outside Patient Access must pass Patient Academy with a score of 85% or higher.
• Previous completion and passing of the Patient Access Advocate II and III Advancement test.

Nice To Haves

• Continued education.
• CHAA, CHAM, or other industry-equivalent specialty certification.

Responsibilities

• Provide exceptional patient and family service using CARES, AIDET, EPE, and PROMISE practices; address complaints and conflicts appropriately and involve a supervisor when needed.
• Educate patients about insurance benefits, liabilities, payment responsibilities, and financial options, and communicate authorization issues in a timely and transparent manner.
• Perform patient registration and collect, confirm, and enter demographic, financial, and clinical information needed to clear scheduled accounts.
• Review urgent and emergent admissions for notification, financial clearance, and authorization before discharge.
• Obtain missing insurance information and verify eligibility and benefits through electronic systems or direct contact with payers.
• Review and process Patient Access pre-visit and urgent or emergent admission work queues according to department guidelines.
• Check account details, including policy and group information, subscriber details, authorization numbers, payer information, and coordination of benefits.
• Document actions accurately in the system of record and maintain appropriate records and files to support effective follow-up and an audit trail.
• Maintain knowledge of authorization requirements, payer guidelines, Medicare requirements, admissions forms, benefit entitlement verification, and billing requirements.
• Complete the Medicare Secondary Payer Questionnaire (MSPQ) accurately before the date of service.
• Meet productivity standards, recommend performance and productivity improvements when appropriate, and monitor Data Quality program items to correct errors before final billing.
• Coordinate with ancillary departments to align coding, diagnosis, facility, and authorization; work with payers to obtain authorizations, initiating them when appropriate.
• Coordinate with Financial Advocates to secure payer sources for current and future visits.
• Monitor work queues for late add-on accounts and complete financial clearance procedures before services to help prevent unauthorized procedures.
• Work with physician offices to resolve discrepancies involving authorizations and scheduled procedures.
• Collect identified patient financial obligations, including applicable residual balances, before visits 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.
• Contact patients before visits to obtain missing account information, answer questions, explain liabilities, and provide appointment way-finding when needed.
• 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.
• Provide coverage to other areas and hospitals as needed 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.
• Other optional voluntary benefits.
• Employee Wellness rewards program offering 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