Central Scheduling - Patient Access Associate III - 40hrs

Connecticut Children's•Hartford, CT

About The Position

Under limited supervision, independently coordinates and performs multiple complex functions within the Patient Access department. Uses considerable judgment to interpret departmental policies and resolve routine-to-complex inquiries and patient account problems. Identifies process-improvement opportunities, proposes and implements solutions, represents the department in meetings, and serves as a primary resource to team members for training and problem resolution. Performs duties in support of Connecticut Children’s mission, values, and standards. The role covers administrative support, registration, appointment scheduling, front-office check-in, financial clearance, financial counseling, and financial responsibility. It includes collecting and verifying patient, guarantor, insurance, and financial information; processing forms and authorizations; managing patient account and scheduling work queues; resolving outstanding issues; and coordinating with patients, families, clinical teams, insurers, and hospital departments. The position also provides quality assurance, staff training, workflow coordination, and may delegate daily assignments.

Requirements

High school diploma, GED, or higher education that includes completion of high school.
Healthcare experience.
Two to four years of directly related experience.
CHAA (Certified Healthcare Access Associate) certification within one year.
Advanced knowledge of Microsoft Word and Excel.
Knowledge of ADT systems and insurance verification systems; EPIC is preferred.
Knowledge of managed care, referrals, pre-certification and authorization, denials, patient accounts, and DSS.
Computer, typing, and data-entry skills.
Excellent verbal and written communication skills.
Excellent organizational skills and ability to provide feedback to staff.
Ability to work in a fast-paced, high-volume environment and alongside multiple disciplines.
Ability to coordinate workflows, anticipate and rebalance workloads, guide and train staff, delegate effectively, and conduct crucial conversations independently.

Nice To Haves

Bachelor’s or associate’s degree strongly preferred.
One year of directly related Connecticut Children’s experience preferred.
Experience with EPIC.

Responsibilities

Provide receptionist, secretarial, Health Unit Coordinator, and other administrative support according to department protocol.
Respond compassionately and professionally to patients and families while protecting privacy and confidentiality under HIPAA policies.
Create staffing assignments and coordinate or delegate tasks and work assignments.
Train staff, conduct quality assurance, identify process trends, and provide follow-up education to improve performance.
Audit registration data and documentation, including incomplete information, patient and guarantor interactions, collection efforts, and referrals to Medicaid; ensure outstanding issues are resolved and reviewed on schedule.
Maintain spreadsheets and databases, ensure employee drawers are closed according to standard process, and liaise with Patient Accounting on denials and account problems.
Collect and enter accurate demographic, guarantor, insurance, and financial information for emergency, inpatient, outpatient, and physician-practice visits.
Verify insurance and billing information, use appropriate payer plan codes, generate required forms, and obtain patient, parent, or legal guardian signatures for authorizations and consent.
Pre-register and register patients, update information in ADT systems, address patient questions, and seek feedback about the visit.
Attempt to collect patient liability and co-payments; document incomplete information, insurance verification, patient interactions, collection efforts, and Financial Counseling referrals.
Follow up on open items, work registration queues, and provide feedback to front-end staff on accurate and complete registration.
Schedule routine and complex appointments in person or by telephone; create provider appointments, coordinate with other hospital areas, and build and maintain scheduling templates.
Ensure consent and privacy forms are signed and coordinate with DCF to obtain appropriate signatures and legal guardian information.
Check patients in and out, update demographic and insurance information, secure patient financial liability, enter charges, schedule or reschedule appointments, answer and triage calls, and perform other front-office duties.
Manage scheduled and unscheduled appointment work queues; obtain insurance benefits, referrals, and authorization requirements; communicate eligibility and authorization information to clinical and office staff.
Review charts and submit documentation for authorizations; coordinate with payers, primary care providers, Utilization Review, clinicians, and insurance representatives to resolve authorization issues and delays.
Refer patients and families to Financial Counseling for eligibility or financial issues, and notify clinical staff of denials requiring further action.
Maintain tracking of outstanding issues that may delay or result in authorization denials, coordinate daily assignments, and escalate clinic concerns to management.
Review patient accounts, obtain insurance benefits, support Financial Counselors, interview patients or families about insurance and financial information, explain financial policies, and complete financial evaluation forms.
Assist patients and families with DSS and Financial Assistance processes; assess potential eligibility, establish payment arrangements, and follow up on reasons for non-payment.
Verify insurance coverage using available methods, facilitate certification, maximize payment from commercial and managed-care plans, and follow up on outstanding account issues.
Apply knowledge of age-related needs from neonates through adolescents and demonstrate cultural sensitivity in patient and family interactions.
Coordinate daily departmental activities when assigned, delegate staff assignments, serve as a first-level resource to staff and leadership, and participate in at least one hospital committee.