Patient Access Specialist - Full Time - Day

Hackensack Meridian Health•North Bergen, NJ

2d•$25

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 hospital locations. The role conducts patient interviews, confirms identity and demographics, obtains required consents and regulatory forms, and screens insurance coverage, network status, and coordination of benefits. It supports scheduling, bed planning, pre-registration, registration, insurance verification, pre-certification, financial clearance, and point-of-service collections under the direction of Patient Access leadership. The specialist follows patient safety, regulatory, departmental, and quality standards while maintaining a positive patient experience. The position also handles patient and payer communications, resolves or escalates access and coverage issues, processes payments and documents, completes Epic work queues and pre-registration workflows, and coordinates admission notifications and authorization activity. The specialist may work in different Access Services areas and rotate shifts according to departmental needs.

Requirements

High school diploma, GED, or GED-equivalent program.
At least 1 year of experience in a hospital setting.
Ability to work rotating schedules or shifts based on departmental needs.
Good written and verbal communication skills.
Customer-service orientation.
Basic knowledge of medical terminology.
Proficient computer skills, including Microsoft Office and/or Google Suite platforms.
Ability to work every other weekend.
Ability to work three out of six holidays.
Successfully complete EPIC Cadence and Prelude training and pass the subsequent assessment within 30 days after network access is granted.

Nice To Haves

Bachelor's degree and/or related experience.
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 medical terminology knowledge.
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.
Implement scheduling, pre-registration, pre-certification, referral procurement, and insurance verification policies and procedures for assigned outpatient areas.
Follow patient identification policy and perform accurate patient searches to maintain safety and prevent duplicate medical record numbers.
Track patient location and arrival/processing times and support prompt service within departmental guidelines.
Ensure regulatory forms and consent forms are completed and signed.
Perform bed-planning functions, including reservations, pre-registration, and bed assignment; prioritize assignments according to policy and ensure patients are assigned to the appropriate unit and level of care.
Review orders to confirm appropriate patient status and level of care.
Run and review real-time eligibility queries, confirm plan codes and coordination of benefits, and complete Medicare Secondary Payer Questionnaires accurately.
Verify inpatient and outpatient insurance, benefits, coverage, and pre-authorization requirements; follow up with referring physicians and payers to ensure authorizations are on file before service.
Use the EPIC Financial Estimator to determine patient out-of-pocket responsibility and pursue upfront collections where appropriate.
Explain financial responsibilities and available financial resources, accept payments, and refer patients to Financial Counselors when appropriate.
Submit treatment and procedure data in a timely manner to obtain authorizations and support reimbursement.
Enter accurate diagnosis data that meets medical necessity criteria and comply with patient financial responsibility and collection policies.
Provide patients with appropriate administrative information and ensure compliance with federal and state requirements.
Manually register patients during system downtime and follow required registration input procedures when systems return.
Mediate scheduling, pre-registration, pre-certification, and registration issues; escalate unresolved issues.
Complete assigned work queue accounts in a timely and efficient manner.
Identify patient population needs and adapt communication and service to age, culture, language, hearing, visual, developmental, educational, and literacy needs.
Deliver excellent customer service and coordinate daily departmental activities that promote patient comfort and trust.
Scan documents and correspondence from patients and payers; obtain, type, copy, file, and fax patient records and scheduling information as needed.
Schedule patients as needed, answer a high volume of phone calls professionally, and resolve issues promptly and accurately.
Ensure timely notification of admissions to payers and refer accounts to Case Management for timely clinical information submission.
Work with patients to financially clear accounts according to policy at least three days before procedures and escalate coverage complications.
Process accepted payments accurately, reconcile daily cash drawers or shift transactions, deposit cash and checks, and provide receipts and/or service estimates.
Complete appropriate Epic pre-registrations, clear checklists, and set account status to Confirmed pre-reg.
Contact patients and physicians' offices regarding Pre-Admission Testing scheduling.
Work in Access Services areas across the hospital and rotate shifts as needed.
Check email daily for process and task updates and meet departmental productivity and process standards.
Adhere to HMH organizational competencies, standards of behavior, procedural workflows, and departmental policies; perform other assigned duties and projects.