Patient Access Specialist - Per Diem - Day

Hackensack Meridian Health•Edison, NJ

About The Position

The Patient Access Specialist performs inpatient and outpatient patient access functions within the Patient Access Services Department at assigned Hackensack Meridian Health locations. The role conducts patient interviews, verifies identity and demographics, screens insurance coverage and coordination of benefits, obtains required consents, and supports scheduling, bed planning, pre-registration, registration, insurance verification, pre-certification, point-of-service collections, and financial clearance. The specialist works under the direction of the Supervisor, Manager, or Director for the designated areas and follows medical center quality standards while maintaining a positive patient experience. The position also supports patients with information about financial responsibility and available resources, processes payments and registration documentation, coordinates with payers and referring offices, and helps ensure coverage and authorizations are confirmed before services. The specialist may work across Access Services areas in the hospital and rotate shifts as needed.

Requirements

High school diploma, GED, or equivalent program.
Ability to work rotating schedules or shifts based on operational needs.
Ability to work every other weekend.
Ability to work three out of six holidays.
Good written and verbal communication skills.
Customer-service orientation.
Basic knowledge of medical terminology.
Proficient computer skills, which may include Microsoft Office and/or Google Suite.
Successfully complete EPIC Cadence and Prelude training and pass the associated assessment within 30 days after network access is granted.

Nice To Haves

Bachelor’s degree and/or related experience.
At least one year of experience in a hospital setting.
Patient financial services experience in a professional or hospital setting.
Prior registration or insurance verification experience.
Excellent analytical, written and verbal communication, and interpersonal skills.
Proficient knowledge of medical terminology.
Knowledge of insurance specifications, ICD-10, and CPT-4 codes.
Bilingual ability, such as Spanish or Korean.
Experience with EPIC HB, Cadence, and Prelude.

Responsibilities

Greet patients and visitors in person and by phone in a prompt, courteous, respectful, and helpful manner.
Apply scheduling, pre-registration, pre-certification, referral procurement, and insurance verification procedures for assigned outpatient service areas.
Follow patient identification procedures, conduct accurate patient searches, and help prevent duplicate medical record numbers.
Check in patients and track their locations and arrival or processing times to support prompt service within departmental guidelines.
Ensure regulatory forms are completed and signed by patients.
Perform bed-planning functions, including reservations, pre-registration, and bed assignment; prioritize assignments according to policy and ensure placement aligns with the admit order and appropriate level of care.
Run real-time eligibility queries for eligible insurance plans, review results, assign correct plan codes, and verify coordination of benefits.
Complete Medicare Secondary Payer Questionnaires accurately.
Verify insurance for inpatient and outpatient services and determine patient out-of-pocket responsibility using the EPIC Financial Estimator tool.
Explain patient financial responsibilities and available financial resources, and collect payments where appropriate using accepted payment methods.
Verify coverage and benefits for scheduled procedures and check pre-authorization requirements; follow up with referring physicians and payers to ensure authorizations are on file before service.
Submit treatment and procedure information promptly to support authorization and reimbursement processes.
Ensure registration diagnosis data is accurate and meets medical necessity criteria.
Follow patient financial responsibility and collection policies and provide appropriate administrative information to patients.
Comply with federal and state requirements and obtain required signatures on regulatory and consent forms.
Register patients accurately during system downtime and follow registration input procedures when systems become available.
Attempt to resolve scheduling, pre-registration, pre-certification, and registration issues, escalating unresolved issues as needed.
Complete assigned work-queue accounts efficiently and on time.
Identify the needs of the patient population and adapt communication and service to patients’ age, culture, language, literacy, and accessibility needs.
Maintain excellent customer service and a positive patient experience while following workflows and departmental policies.
Scan patient and payer documents and correspondence.
Coordinate daily Patient Access Department activities to foster patient comfort and trust.
Schedule patients as needed and respond professionally to a high volume of phone calls, resolving issues promptly and accurately.
Notify payers of admissions in a timely manner and refer accounts to Case Management for timely clinical-information submission.
Access payer websites, including Navinet, to confirm insurance coverage and benefits.
Financially clear patient accounts according to policy at least three days before procedures, resolve coverage issues, escalate complications, and refer patients to Financial Counselors when appropriate.
Process accepted payments accurately, reconcile cash drawers or shift transactions, deposit daily cash and checks, and provide receipts or service estimates.
Complete pre-registration in Epic for appropriate patients, clear Epic checklists, and set account status to Confirmed pre-reg.
Contact patients and physician offices about Pre-Admission Testing scheduling.
Obtain patient records and accurately process scheduling information, including copying, filing, faxing, and phone support.
Work in Access Services areas throughout the hospital and rotate shifts as needed.
Check email daily for process and task updates.
Meet departmental daily productivity and process standards.
Complete other assigned duties or projects and adhere to HMH organizational competencies and standards of behavior.