Patient Access Specialist

Mercyhealth Wisconsin and Illinois•Janesville, WI

13d•$21 - $32•Onsite

About The Position

Mercyhealth is seeking a Patient Access Specialist to join their team. This role is responsible for researching payer denials, submitting appeals, identifying denial patterns, and ensuring compliance with access and revenue cycle policies. The specialist will also be responsible for obtaining and documenting referrals/authorizations/pre-certifications, contacting insurance companies for eligibility and benefits, and maintaining knowledge of payor provisions and regulations. The position requires excellent customer service skills, accurate documentation in EMR systems, and adherence to patient confidentiality and HIPAA regulations. Additionally, the role involves performing clerical duties, acting as a subject matter expert, and providing training to new team members. The Patient Access Specialist will review external orders/referrals to ensure compliance and manage other assigned duties.

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 resulting in denials and delays in payment.
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 with sufficient information for additional follow-up, and/or root cause resolution.
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 to ensure correct data is gathered and documented.
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.
Subject matter expert with regards to assigned responsibilities.
Provides training to new partners, as well as on an as-needed basis.
Ensures compliance with Patient Access and Revenue Cycle related policies and procedures.
Reviews external orders/referrals to ensure authorization and compliance requirements are met.
Manages other duties as assigned.