Patient Access Specialist

Hackensack Meridian Health•Hackensack, NJ

14d

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, confirms identity and demographics, obtains required consents, and screens Medicare, Medicaid, and managed-care patients for network status and coordination of benefits. Functions include facility-based scheduling, bed planning, pre-registration, registration, insurance verification, pre-certification, point-of-service collections, and financial clearance, under the direction of Patient Access leadership. The specialist follows Medical Center quality standards and supports a positive patient experience. The role works across Patient Access areas as needed and may rotate shifts. It includes interacting with patients, caregivers, physicians’ offices, payers, and other departments; handling scheduling and registration workflows; verifying coverage and authorizations; explaining financial responsibility and payment options; processing payments; and maintaining accurate records and timely work-queue completion. The specialist adapts communication and service to patients’ age, culture, language, literacy, and accessibility needs.

Requirements

High school diploma, GED, or equivalent.
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.
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 and 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 promptly, courteously, respectfully, and helpfully in person and by phone.
Apply scheduling, pre-registration, pre-certification, referral procurement, and insurance-verification policies and procedures.
Follow patient-identification policy and perform accurate patient searches to support patient safety and prevent duplicate medical record numbers.
Track patient location and arrival or processing times to support prompt service within departmental guidelines.
Ensure regulatory forms and required consent forms are completed and signed.
Perform bed-planning functions, including reservations, pre-registration, and bed assignment; prioritize assignments according to policy and assign patients to the appropriate unit.
Review orders to ensure the patient has the appropriate status and level of care.
Run real-time eligibility queries for eligible insurance plans, review responses, and ensure correct plan codes and coordination of benefits.
Complete the Medicare Secondary Payer Questionnaire accurately.
Verify insurance for inpatient and outpatient services, determine out-of-pocket responsibility using the EPIC Financial Estimator, and confirm that services are covered.
Explain patients’ financial responsibility and available financial resources, pursue upfront collections when appropriate, and process payments accurately.
Verify pre-authorization requirements and follow up with referring physicians’ offices and payers to obtain authorizations before the date of service.
Submit treatment and procedure data promptly to support authorization and reimbursement processes.
Ensure registration diagnosis data is accurate and meets medical-necessity criteria.
Comply with patient financial-responsibility and collection policies and applicable federal and state requirements.
Provide administrative information to patients as directed.
Manually register patients during system downtime and follow registration-input procedures when systems return.
Attempt to resolve scheduling, pre-registration, pre-certification, and registration issues; escalate unresolved matters.
Complete assigned work-queue accounts promptly and efficiently.
Identify patient population needs and adapt communication and service to age, culture, language, hearing, vision, developmental, educational, and literacy needs.
Deliver excellent customer service and comply with workflows, departmental policies, and standards of behavior.
Scan documents and correspondence from patients and payers.
Coordinate daily Patient Access activities to promote patient comfort and trust.
Schedule patients as needed and respond professionally to a high volume of phone calls, resolving issues quickly and accurately.
Notify payers of admissions promptly and refer accounts to Case Management for timely submission of clinical information.
Work with patients to financially clear accounts according to policy at least three days before procedures; resolve coverage issues, escalate complications, and refer to Financial Counselors when appropriate.
Process accepted payment types, reconcile daily cash drawers or shift transactions, deposit cash and checks, and provide receipts and/or service estimates.
Complete pre-registration for appropriate patients in Epic, clear Epic checklists, and set account status to Confirmed pre-reg.
Contact patients and physicians’ offices regarding Pre-Admission Testing scheduling.
Obtain patient records and accurately process scheduling information, including copying, filing, faxing, and answering phone calls.
Work in all Access Services areas within the hospital and rotate shifts as needed.
Check email daily for process and task updates and meet departmental productivity and process standards.
Perform other assigned duties and projects.