Patient Access Coordinator I - Women's Health - West Penn - Full Time

Highmark Health•Pittsburgh, PA

17d

About The Position

The Patient Access Coordinator I completes one or more Patient Access processes, including scheduling, preregistration, financial clearance, authorization and referral validation, and pre-service estimates and collections. The coordinator helps create patients’ and families’ first impression of AHN’s services, explains information clearly so patients and guarantors understand what to expect and their financial responsibilities, and assumes clinical and financial risk for the organization when collecting and documenting information on a patient’s behalf. The role conducts scheduling and preregistration, validates demographic and insurance information, obtains limited clinical data as needed, and ensures accurate and timely billing information. It verifies benefits and authorization or referral requirements, follows up on deficiencies, identifies and collects patient financial responsibilities, and escalates complex or self-pay accounts to Financial Counselors as appropriate. The coordinator also supports positive patient experiences and productive working relationships, meets productivity standards, follows organizational policies, and completes required training.

Requirements

High school diploma or GED; or one to three months of related experience and/or training; or an equivalent combination of education and experience.
One year of previous related experience, preferably in a medical setting, financial services setting, or demanding customer service environment.
Experience operating a PC and using software applications.

Nice To Haves

Knowledge of medical terminology and experience obtaining insurance verifications.
Call or service center experience.

Responsibilities

Conduct scheduling and preregistration; validate patient demographic data, medical benefits, plan codes, and coordination-of-benefits order.
Obtain limited clinical data based on the service required and correct or update information to support timely, accurate bill submission.
Verify insurance information through payor contacts, online resources, or electronic verification systems.
Identify payor authorization and referral requirements, and provide documentation and follow-up to physician offices, case management, and payors regarding deficiencies.
Identify patient financial responsibilities, calculate estimates, collect liabilities, post payment transactions in the ADT system as appropriate, and perform daily reconciliation.
Identify self-pay accounts and complex liability calculations and escalate accounts to Financial Counselors as appropriate.
Deliver a positive patient experience and maintain working relationships with patients, AHN leadership and staff, physician offices, and designated external agencies or vendors.
Communicate as needed with designated contacts to exchange information and promote working relationships.
Maintain focus on productivity standards and recommend innovative approaches to enhance performance and productivity when appropriate.
Follow AHN organizational policies and procedures applicable to the location and job scope.
Complete or attend mandatory training and education sessions within organizational guidelines and timeframes.
Perform other duties as assigned or required.
Comply with the company’s code of business conduct, applicable laws and policies, HIPAA privacy requirements, and information security guidelines.