Patient Access Specialist

Total Health Care•Odenton, MD

20d•$18 - $21

About The Position

The Patient Access Specialist (PAS) reports to the Revenue Cycle Manager and/or their designee. The PAS confirms patient demographic and insurance information and enters required information into Total Health Care’s electronic medical record systems to support accurate billing across dental, medical, mental health, and substance abuse departments. The role identifies patients who may need financial assistance and assists them in accordance with THC policies and procedures. The PAS interacts with patients, the public, executive management, community organizers, physicians, colleagues, assigned staff, vendors, insurance payers, managed care organizations, contractors, and consultants to provide and exchange information.

Requirements

High school diploma or equivalent; post-high-school education is preferred. An equivalent combination of education, training, and experience may be considered if it provides understanding of the field and ability to perform the essential functions.
Two years of experience in a healthcare environment in hospital or physician-practice patient registration, customer service, insurance verification, financial clearance, or billing and ICD-9 medical coding.
Certification as a Certified Healthcare Access Associate (CHAA) through NAHAM.
Knowledge of FQHC operations, operating principles, guidelines, and bylaws.
Excellent leadership, customer service, organizational, and presentation skills.
Ability to communicate effectively verbally and in writing.
Ability to plan and organize work initiatives to accomplish center and organizational goals and objectives.
Ability to multitask, prioritize, and delegate as appropriate.
Strong analytical, problem-solving, and interpersonal skills.
Ability to identify, develop, and implement short- and long-term strategic goals and objectives.
Ability to develop and maintain customer relationships and build influence, credibility, and trust.
Ability to think critically and apply critical-thinking skills.
Ability to ensure and advocate for quality healthcare and services and to lead and manage a diverse staff.

Nice To Haves

Post-high-school education.

Responsibilities

Complete insurance eligibility verification for patients scheduled at any THC site or department.
Confirm and enter patients’ current insurance status in the Practice Management System at check-in.
Communicate copayment and payment requirements to patients at the time of service.
Collect payments, copayments, and deductibles at the point of service and post receipts.
Complete the daily self-pay log and obtain the required sign-off.
Reconcile receipts and prepare point-of-service collections for bank deposit.
Follow company procedures for keeping cash secure.
Confirm that THC is listed as the facility providing care and that the patient’s specific THC primary care provider is entered in the Practice Management System.
Confirm authorizations for current and upcoming visits in CESH and Substance Abuse departments.
Obtain secondary QMB cards for qualified patients.
Complete Medicare Secondary Payer questionnaires when needed for coordination of benefits.
Support department goals and KPI measures while maintaining integrity.
Follow up with patients to clarify benefits and correct coordination-of-benefits issues.
Provide financial counseling and information about Maryland Health Connection, including eligibility requirements for applicable federal premium subsidies and cost-sharing assistance.
Facilitate enrollment in Medicaid, MCHP, or a Qualified Health Plan.
Refer applicants and enrollees with grievances, complaints, questions, or other social-service needs to appropriate agencies, including the Attorney General’s Health Education and Advocacy Unit and the Maryland Insurance Administration.
Scan the front and back of patients’ insurance and identification cards for upload to the EMR.
Complete primary care provider change forms when provider information is invalid, submit them by secure fax, and obtain fax confirmation on the day of the visit.
Assist patients with completing Intake/Consent forms and OMS.
Obtain signatures and documentation required by patients’ insurance plans.
Determine the appropriate financial class and/or account type and correctly assign primary and secondary insurance billing status when coordination of benefits is required.
Determine patients’ eligibility for the 30-day or 6-month sliding fee scale.
Monitor patients on the 6-month sliding fee scale for appropriateness and insurance eligibility status.
Track Department of Social Services vouchers and other third-party or community payer documentation, as well as medical forms, and submit them to the Revenue Cycle Manager for billing.
Perform other duties as assigned.