Patient Access Specialist I

Taylorville Memorial Hospital - Jacksonville, IL

Jacksonville, IL

Hospitals

About the position

Assists in providing access to services provided at the hospital and/or other service area. Processes registration information for the patient visit, obtaining patient demographic and third party information with a high degree of accuracy, and performs financial collections. Performs the timely completion, preparation, and deployment of legal, ethical and compliance related documents that must be presented and thoroughly explained to the patient at the time of registration. Maintains knowledge of JCAHO, Patient Rights and Responsibilities, HIPAA, HMOs, Commercial Payers, and departmental / system policies and procedures. Provides Mammography Screening scheduling services to patients. Work may be performed in a patient care area. Serves as a liaison between ancillary departments and other Patient Access Services areas.

Responsibilities

• Completes all steps of pre-registration/registration; verifies patient identity and demographic information through appropriate tools.
• Identifies/captures appropriate health insurance benefit eligibility based on contract/regulatory differentiation.
• Facilitates appropriate billing of claims and hospital reimbursement.
• Obtains and validates proper consent for patient treatment.
• Schedules patients for Mammography procedures efficiently, effectively, and according to established protocol.
• Educates patients/others regarding the resolution of billing, private pay options, collection efforts, coordination of benefits, third party and governmental payment criteria, insurance coverage, payments, and denials.
• Coordinates with SMH Patient Financial Services, Utilization Management, physicians, and medical offices to ensure consistent financial documentation.
• Adheres to all CMS Conditions of Participation regulations and Section 1154(e) of the Social Security Act.
• Verifies medical necessity, and obtains appropriate signature on Advance Beneficiary Notice of non-coverage (ABN).
• Negotiates with patients and families to collect patient co-pays and/or deposits at point of service.
• Triages, documents, and initiates referrals of patients to Medicaid vendor and/or for financial assistance.
• Identifies/reviews services requiring pre-authorization/pre-certification by Medicare, Medicaid, Commercial, and Managed Care payers.
• Analyzes reports containing rejected accounts and resolves toward verification of patient benefit eligibility.
• Orients and cross-trains others within assigned area of responsibility.
• Ensures compliance with all applicable HIPAA, Joint Commission, CDC, SMH, and state and federal statutes.
• Maintains current knowledge of, and complies with, the Illinois Fair Patient Billing Act and Illinois Uninsured Patient Discount Act.
• Completes Illinois DHS legal forms for psychiatric admits, in compliance with State of Illinois and SMH statutes and guidelines.
• May rotate work settings, i.e., patient registration, bedside registration, or other SMH campus environments.
• Develops and maintains a comprehensive knowledge of the health system organization and its functions.
• Meets expectations for productivity, accuracy, and point of service collections.
• Attendance at quarterly department meetings is mandatory unless absence is approved by PAS management.
• Performs pre-registration functions as requested.
• Performs other related work as required or requested.

Requirements

• High School diploma required.
• One (1) years of business office experience, preferably in the areas of Patient Access, billing, collections, insurance principles/practices, or accounts receivable.
• Completion of 12 (twelve) hours of coursework in a business or healthcare related field of study may be considered in lieu of business office experience.
• Previous experience in Patient Access is highly desirable.
• Knowledge of all tasks performed in the various Patient Access Service areas.
• Demonstrates superior patient relations and interpersonal skills.
• Working knowledge of computers is required.
• Must demonstrate detail orientation, critical thinking, and problem solving ability.
• Must demonstrate excellent oral and written communication and customer service skills.
• Demonstrated ability to remain flexible and exercise sound judgment in stressful situations.
• Ability to effectively manage competing priorities and work independently.

Nice-to-haves

• Knowledge of medical terminology, medical procedural (CPT) and diagnosis (ICD 10 CM) coding, and hospital billing claims preferred.