Patient Access Specialist Sr

INTEGRIS Health•Oklahoma City, OK

17h

About The Position

The Patient Access Specialist Sr. provides patient access services for assigned ancillary, diagnostic, surgical, and emergency services, supporting efficient operations, timely reimbursement, and patient and employee satisfaction. The role acts as a liaison among INTEGRIS Health, patients, providers, and payers on pre-care matters related to account resolution, and explains coverage eligibility and benefits, patient financial liability, and INTEGRIS Health billing practices and policies. The specialist handles complex registration and patient access transactions, including scheduling, verifying demographic information, processing point-of-service payments, collecting required consent signatures, imaging documents, verifying insurance coverage and eligibility, calculating patient portions, and addressing authorization requirements. The role responds to patient and payer questions, resolves account issues, documents account activity, and uses analytical thinking, independent judgment, and clinical knowledge to adjust schedules and accommodate requests. As a senior resource, the specialist supports and trains other patient access staff, provides guidance and feedback, monitors assignments and productivity, and serves as a systems and process resource. The role also coordinates process and quality improvement initiatives, tracks goals and progress, prepares data for presentation, and maintains compliance with applicable performance standards, federal and state regulations—including EMTALA and HIPAA—organizational policies, procedures, guidelines, and third-party contracts.

Requirements

Four years of patient access operations experience in scheduling, registration, or insurance, or related experience in billing, collections, or accounts receivable.
Previous experience in scheduling, registration, insurance, billing, collections, or customer service in a hospital or physician's office setting.

Nice To Haves

Bachelor's degree in a related field or healthcare certification such as AAHAM CRCS, HFMA CRCR, or NAHAM CHAA.
Experience with Microsoft Office programs and admission/discharge/transfer or billing/claims management software.
Experience with medical terminology, basic ICD-10 and CPT coding, healthcare program reimbursement, and reimbursement methodologies.
Experience in three or more of the following in a hospital or physician's office setting: scheduling, registration, insurance (including Medicare, Medicaid, and third-party regulations), billing, collections, and customer service.

Responsibilities

Perform complex registration activities, including scheduling, verifying patient demographic information, processing point-of-service payments, obtaining signatures for consent paperwork, imaging documents, and following documentation standards.
Perform complex patient access transactions, including coverage eligibility and insurance verification, patient portion calculations, and authorization requirements, using available systems and resources.
Use analytical thinking, independent judgment, and clinical knowledge to adjust service area schedules and accommodate special requests from internal and external customers.
Answer inbound calls from patients, physician offices, insurance carriers, and others, with the goal of resolving concerns promptly.
Collect patient payments and follow applicable levels of authority to ensure financial clearance.
Document patient account activity concisely, including authorization and patient liability requirements.
Perform filing, data entry, and other assigned duties.
Respond to patient inquiries about pre-care services, policies, coverage, benefits, and financial liability.
Use multiple resources to resolve patient or payer inquiries and review patient accounts or prior authorization requirements.
Explain payer regulations, coverage benefits, and financial liability to patients.
Act as a liaison to resolve complex patient access and account issues, respond to reimbursement questions, and serve as a resource and systems expert for patient access specialists.
Provide staff guidance, feedback, and training on processes, payers, and systems; monitor assignments and assess productivity.
Communicate effectively by telephone, email, and verbally with departments and caregivers throughout the health system.
Initiate and coordinate team-oriented process improvement initiatives for the department and organization.
Coordinate continuous quality improvement efforts, establish goals with supervisors, track progress, and prepare data for presentation.
Interpret and maintain compliance with performance standards, EMTALA, HIPAA, federal and state regulations, policies, procedures, guidelines, and third-party contracts.