Patient Access Specialist

Texas Children's Medical Center•Houston, TX

11h

About The Position

We are searching for a Patient Access Specialist — someone who works well in a fast-paced setting. In this position, you will ensure timely and accurate patient registration by serving as the liaison between patient/family, payers, providers, Healthcare Information Management (Medical Records), Patient Financial Services (PFS or Business Services) and other health care team members. While utilizing a unique medical record number, the Patient Access Specialist will facilitate patient tracking and billing by obtaining/verifying accurate and complete demographic information, financially securing, ensuring financial authorizations, and collecting out-of-pocket responsibility from guarantors to maximize hospital reimbursement. Think you’ve got what it takes?

Requirements

High School Diploma or GED
2 years Patient access registration or patient accounting experience

Responsibilities

Obtains, verifies, and enters complete and accurate demographic information on all accounts to facilitate smooth processing through the revenue cycle.
Financially secures all patient accounts to maximize hospital reimbursement in a customer service-oriented fashion.
Verifies insurance benefits for all plans associated with patient, confirming the correct payor and plan is entered into EPIC.
Ensures financial authorization for service is obtained and to provide the authorizing entity with clinical information including diagnosis and treatment plan.
Facilitates provider communication with payer representative and/or payer Medical Director.
Refers any denials of services or cases with questioned medical necessity to the referring physician or his/her designee for additional information.
Verifies authorization requirements with payer representatives and communicates all necessary information to hospital staff. Facilitates physician-to-physician communication when applicable.
Obtains signatures from patient/guarantor for release of information, general consent to treat, statement of financial responsibility, Medicare and Champus forms, and other required paperwork, as measured by account audits, medical record review, and feedback from downstream departments.
Provides continuous support of process improvements through compilation of data, excellent customer service, monitoring and evaluation of departmental roles, and proposals for process improvement initiatives.
Provides in-service training for departments, either in staff meetings or through individual meetings to ensure initiations are completed accurately and inform staff of any pre-authorization updates from insurance providers.