Patient Access Specialist

OMNI FAMILY HEALTH•Bakersfield, CA

47d•$23 - $26

About The Position

The Patient Access Specialist facilitates timely access to care by verifying patient eligibility and benefits before services. The role works with health plans to help patients transfer to an Omni Family Health (OFH) provider and obtains prior authorizations when required. The specialist performs checkout, reconciles scheduled appointments with posted charges daily, corrects claims and posting errors, and uses knowledge of commonly used medical terms and procedures. The position also supports patients in identifying appropriate OFH financial assistance programs, coordinates needs with health center leadership, scheduling staff, and navigators, and collaborates with providers and other medical personnel when documentation requires clarification. The specialist is responsible for maintaining confidentiality and complying with HIPAA and other applicable regulations, participating in quality improvement activities, and learning and using the organization’s electronic health record and practice systems. All employees participate in the Patient Centered Health Home Model.

Requirements

High school diploma or GED and at least two years of experience handling billing and accounts receivable in a similar healthcare environment.
Ability to work under pressure and handle multiple functions.
Understanding of community-based organizations.
Effective verbal, nonverbal, and written communication with medical and dental staff and office managers.
Ability to work proficiently, efficiently, and in a timely manner.
Ability to problem-solve and make decisions consistent with organizational policies and procedures.
Ability to work independently and demonstrate initiative, follow-through, and organizational skills.
Knowledge of payer codes.
Knowledge of programs offered by OFH.
Support for and belief in the OFH mission statement.
Ability to relate to the public regardless of ethnic, religious, or economic status.
Good customer service skills and professionalism when interacting with internal and external customers, patients, and staff.
Ability to learn and use the electronic health record and practice electronic systems required for the job.

Nice To Haves

Working knowledge of coding rules, regulations, and third-party payer requirements.

Responsibilities

Verify eligibility and benefits for scheduled patients and same-day appointments according to OFH policy.
Work with Omni staff and health plans to help patients switch to an OFH provider or primary care provider.
Resolve registration and authorization issues before patient visits; obtain authorizations for predetermined procedures when required.
Ensure information needed to complete billing is obtained before patient checkout.
Update patient accounts with information required for billing and review the RTS manager daily to correct errors before patient visits.
Help patients identify an appropriate OFH Financial Assistance Program and coordinate their needs with health center leadership, scheduling staff, and navigators.
Research documentation with physicians or other medical personnel when clarification is needed.
Maintain effective working relationships with OFH providers and health center leadership.
Post charges for completed encounters during checkout.
Correct claims and posting errors and reconcile scheduled appointments with posted charges daily.
Perform other related duties as directed by the Billing Supervisor.
Maintain awareness of and comply with HIPAA regulations and requirements; keep member information confidential.
Ensure compliance with local, state, and federal regulations.
Participate in QA/QI activities and contribute to organizational performance improvement.
Learn and use the Electronic Health Record and Practice Electronic System and applicable components, including NextGen, PMS, and QSI.
Participate in the Patient Centered Health Home Model.