Patient Access Specialist

OMNI FAMILY HEALTH• Fresno, CA, US, CA

6d•$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 transfer patients to Omni Family Health (OFH) and obtain prior authorizations when required. It also performs patient checkout, reconciles scheduled appointments with posted charges daily, corrects claims and posting errors, and applies knowledge of commonly used medical terms and procedures. The position supports patients in identifying appropriate OFH financial assistance programs and coordinates related needs with Health Center leadership, scheduling, and Navigators. It works with providers and other medical personnel to clarify documentation as needed and maintains effective working relationships with OFH providers and Health Center leadership. The role must comply with HIPAA and applicable regulations, participate in quality improvement activities, learn and use the organization’s electronic health and practice systems, and participate in the Patient Centered Health Home Model.

Requirements

High school graduate or GED.
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 and programs offered by OFH.
Belief in and promotion of 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 maintain HIPAA compliance and confidential handling of member information.

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 (PCP).
Resolve registration and authorization issues before patient visits; obtain authorizations for predetermined procedures when required.
Ensure all information needed to complete billing is obtained before patient checkout.
Update patient accounts with pertinent billing information and review the RTS manager daily to correct errors before patient visits.
Help patients identify the OFH Financial Assistance Program appropriate to their needs, coordinating with Health Center leadership, scheduling, 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.
Maintain HIPAA compliance and confidentiality of member information, and 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.
Perform other related duties as directed by the Billing Supervisor.