Patient Access Coordinator I - Valley Brook - McMurray - FT

Highmark Health•Mcmurray, PA

About The Position

Completes one or more Patient Access processes, including scheduling, preregistration, financial clearance, authorization and referral validation, and pre-service estimates and collections. The position creates the first impression of AHN’s services for patients, families, and external customers, and explains information so patients, guarantors, and family members understand what to expect and their financial responsibilities. The role assumes clinical and financial risk for the organization when collecting and documenting information on patients’ behalf. The coordinator conducts scheduling and preregistration, validates demographic and insurance information, obtains limited clinical data as needed, and updates records to support timely and accurate billing. The role verifies insurance and authorization or referral requirements, follows up on deficiencies, identifies and estimates patient financial responsibilities, collects payments, and reconciles transactions. It also supports positive patient experiences and productive working relationships, meets productivity standards, follows organizational policies, and completes required training. Employees must comply with applicable laws and company policies, including HIPAA and information security requirements, and protect confidential information.

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 related experience, preferably in a medical setting, financial services setting, and/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 center 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 as required; and update information to support timely, accurate billing.
Verify insurance information through payor contacts, online resources, or electronic verification systems; identify authorization and referral requirements; and provide documentation and follow-up regarding deficiencies to physician offices, case management, and payors.
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 effective 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 support working relationships.
Maintain focus on productivity standards and recommend approaches to improve 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 applicable laws, the Code of Business Conduct, company policies and training requirements, HIPAA, and information-security policies; protect confidential information.