Patient Access Specialist

Mercyhealth•Janesville, WI

5d•Onsite

About The Position

The Patient Access Specialist is responsible for researching payer denials, initiating appeals, and ensuring compliance with access and revenue cycle policies. This role involves contacting insurance companies to determine eligibility and benefits, documenting activities in the EMR system, and maintaining patient confidentiality. The specialist will also provide training to new team members and review external orders for authorization compliance. Additionally, they perform various clerical duties and manage other assigned tasks to ensure a quality patient experience and efficient revenue cycle management.

Requirements

Two years of healthcare registration, scheduling, or physicians' office experience required.
Healthcare revenue cycle related certification or an equivalently designated certification approved by management required within 1 year of hire.

Nice To Haves

High school diploma or equivalent preferred.
Two years of customer service experience preferred.

Responsibilities

Research payer denials related to referral, pre-authorization, medical necessity, case management, non-covered services, and billing.
Initiate appeals with insurers appropriately.
Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare, Medicaid, and third-party guidelines as well as Mercyhealth Revenue Cycle policies and procedures.
Identify denial patterns and escalate to management as appropriate.
Initiates, obtains, and documents referrals/authorizations/pre-certifications in appropriate systems.
Ensures compliance with Access and Revenue Cycle related policies and procedures.
Completes accounts in assigned work queues.
Maintains a high level of professionalism and provides a quality patient experience.
Ensures compliance with reporting related to demographics and federal and state requirements.
Contacts insurance companies or employer groups via phone, web portals, electronic applications, or other appropriate means to determine eligibility and benefits for necessary services to obtain financial resolution and payment on account.
Maintains current knowledge of payor payment provisions and regulations.
Documents activity within appropriate EMR or patient accounting systems.
Demonstrates an understanding and follows patient confidentiality policies and all HIPAA Regulations.
Performs other clerical duties as needed such as faxing, filing and photocopying.
Provides training to new partners, as well as on an as-needed basis.
Reviews external orders/referrals to ensure authorization and compliance requirements are met.
Manages other duties as assigned.