Patient Access Advocate-Senior

Presbyterian Healthcare Services•Remote Workers New Mexico, NM

3d•$19 - $29•Remote

About The Position

The Senior Patient Access Advocate provides all services needed to resolve the financial clearance of patient accounts of government and commercial accounts prior to billing. Performs all financial clearance functions, including insurance verification, authorization, collection and documentation of patient demographics, quality assurance of registration data, benefit analysis, financial counseling, and pre and post service collections.

Requirements

High school diploma/GED
Internal Candidates: 5 years experience in healthcare setting with 2 years of Patient Access and/or billing plus strong customer service background.
Previously passed Patient Access Advocate II, III and Specialist Advancement tests.
Expert knowledge of insurance and financial processing of accounts
Expert knowledge of medical terminology and billing codes (DRG, ICD-10, CPT, HCPCS)
Proficient in EPIC ADT system; include scheduling, registration, contract requirements, financial guidelines, coordination of services and billing process.
Proficient in Microsoft Office Products.
Candidates must be at least 18 years of age at the time of hire

Nice To Haves

CHA, 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.
Ensures accounts are cleared for billing to alleviate patient concerns over hospital financial matters
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 post discharge.
Obtain missing insurance information which can include policy number, group number, date of birth, and insurance phone number if information is missing from 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 to ensure claims are submitted timely and accurately, per department guidelines.
Quality 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 billing.
Obtain retro authorization for accounts in which the authorization was pending or not received prior to discharge
Maintain a strong knowledge of Medicare (CMS) guidelines as it relates to admissions and outpatient services.
Ensuring we are in compliance with admissions forms, benefit entitlement verification, and billing requirements
Quality check accounts relative to MSPs and other Compliance regulations.
Report out inaccuracies to leadership as appropriate.