Patient Access Specialist I

Memorial Health•Springfield, MA

26d•$16 - $24

About The Position

The Patient Access Specialist plays a key role in ensuring that patients have timely and efficient access to hospital and service area resources. This position is responsible for processing patient registration information with high accuracy, including collecting demographic and insurance details and performing financial collections. Key Responsibilities: Registration and Information Accuracy: Collect and verify patient demographics, insurance information, and financial details. Ensure all registration data is accurate and complete, facilitating the patient’s timely access to services. Compliance and Documentation: Prepare and present legal, ethical, and compliance-related documents, ensuring patients understand and complete all required forms during registration. Maintain knowledge of JCAHO standards, Patient Rights and Responsibilities, HIPAA regulations, and payer requirements. Mammography Screening Scheduling: Provide scheduling services for mammography screenings, following established protocols for insurance, exam type, patient preferences, and urgency. Coordination with Departments: Act as a liaison between Patient Access Services and ancillary departments, facilitating communication and ensuring a smooth flow of information and services for patients. Financial Collections: Perform financial collections, including co-pays and deposits at the point of service. Educate patients regarding billing, insurance coverage, and payment options. Regulatory Compliance: Adhere to CMS Conditions of Participation, obtaining necessary signatures (ABN, consent forms) as required by CMS regulations. Cross-Department Collaboration: Support patient care areas as needed, helping ensure timely and accurate documentation for patient services. Other Duties as Assigned: Complete all other duties and special projects as assigned by management to support the department's goals and ensure consistent patient care.

Requirements

High school diploma required
Must successfully complete assigned annual education through Healthcare Business Insights
Minimum of one (1) year of business office experience, preferably in areas such as Patient Access, billing, collections, insurance principles/practices, or accounts receivable
Completion of 12 (twelve) hours of coursework in a business or healthcare-related field may be considered in lieu of business office experience
Comprehensive knowledge of tasks performed across various Patient Access Service areas to ensure customer satisfaction and accurate reimbursement
Excellent interpersonal and patient relations skills, with the ability to maintain emotional composure and exercise sound judgment in all interactions
Working knowledge of computers, including the ability to enter and retrieve data from registration software and other required applications/systems
Strong attention to detail, critical thinking, and problem-solving abilities
Excellent oral and written communication skills, with the ability to maintain professionalism in high-pressure situations
Flexibility and the ability to exercise judgment and initiative, especially in stressful or rapidly changing environments
Ability to manage competing priorities independently and effectively
Strong negotiation and persuasion skills when educating and communicating with patients and families

Nice To Haves

Previous experience in Patient Access is highly desirable
Knowledge of medical terminology, medical procedural (CPT), and diagnosis (ICD-10 CM) coding, as well as hospital billing claims is preferred but not required

Responsibilities

Completes all steps of pre-registration/registration, verifies patient identity and demographic information, and captures health insurance benefit eligibility based on contract/regulatory requirements. Ensures proper consent for patient treatment is obtained.
Schedules patients for Mammography procedures according to established protocols, ensuring proper modality, location, insurance requirements, patient preferences, and urgency.
Educates patients on billing resolution, private pay options, collection efforts, coordination of benefits, third-party payments, insurance coverage, payments, and denials. Acts as a liaison between external resources and patients for issues requiring SMH involvement.
Works with Patient Financial Services, Utilization Management, physicians, and medical offices to maintain consistent financial documentation and interdisciplinary collaboration.
Adheres to CMS Conditions of Participation and Section 1154(e) of the Social Security Act, ensuring proper patient signature acquisition. Verifies medical necessity and obtains signatures on Advance Beneficiary Notice of non-coverage (ABN) per CMS regulations.
Negotiates with patients and families to collect co-pays and/or deposits at the point of service, supporting POS collection goals.
Triage, document, and refer patients to Medicaid vendors or financial assistance per the Illinois Fair Patient Billing Act and SMH procedures.
Identifies services requiring pre-authorization and works with physicians to meet eligibility requirements prior to service.
Analyzes and resolves rejected accounts from various hospital sources, ensuring verification of patient benefit eligibility and reimbursement from all payer sources, or suitability for financial assistance.
Orients and cross-trains others within the department and provides coverage during staff absences or special needs.
Ensures compliance with all HIPAA, Joint Commission, CDC, SMH, and state and federal regulations. Educates patients about Advance Directives, Medicare D coverage, and the grievance process as appropriate.
Maintains up-to-date knowledge of applicable regulations, including the Illinois Fair Patient Billing Act and Illinois Uninsured Patient Discount Act, and completes all required annual organizational education.
Completes Illinois DHS legal forms for psychiatric admits in compliance with state and hospital policies, providing relevant education to patients and families.
May rotate between different work settings such as patient registration, bedside registration, or SMH campus environments, and provide coverage for the SMH Financial Lobby Office.
Meets expectations for productivity, accuracy, and point of service collections. Attends quarterly department meetings unless otherwise approved.
Performs other related work as assigned.