Patient Financial Access Specialist OP

Yale New Haven Health•Greenwich, CT

About The Position

The Patient Financial Access Specialist - OP performs all Patient Financial Access Facilitator functions and supports complex scheduling across multiple outpatient service areas. The role uses effective communication and technology to accurately identify patients, follow Red Flag procedures, and obtain or update demographic and financial information across multiple computer systems so visits can be processed in a timely manner. This specialist serves as a liaison between physicians and patients for internal and external appointment and procedure scheduling. Working closely with patients, physicians, and nursing professionals, the role coordinates complex procedures, physician appointments, infusion and chemotherapy, and other multifaceted services. The specialist communicates with patients and physician offices to confirm that instructions, preparations, and laboratory requirements are met before appointments or procedures, and coordinates appointments and demographic information to support appropriate reimbursement. The position makes decisions about whether ordered exams meet Medical Necessity requirements and follows up with patients or physicians when a Waiver or ABN is needed. It also considers imaging and other satellite locations when arranging appointments. Attention to detail, accuracy, and patient sensitivity are essential. The specialist represents YNHHS service excellence, performs statistical and quality assurance functions, and helps develop procedures and plan, implement, and train staff on system improvements.

Requirements

High school diploma or GED required.
Two to three years of work experience in a customer service environment, preferably in a hospital or physician office, with emphasis on registration, scheduling, medical insurance, and eligibility requirements; listed as preferred.
Self-directed, well organized, and team-oriented, with the ability and desire to educate and advocate for patients and families.
Ability to multitask and reprioritize in response to changing volume.
Strong interpersonal skills and ability to build rapport with a wide range of individuals, including clinical staff.
Excellent investigative, critical-thinking, and problem-solving skills.
Intermediate computer skills and ability to adapt to different programs and systems.
Proficiency in understanding registration work queues that affect workflow.
Ability to provide training or in-service education to staff in the department and hospital.
Effective written and oral communication skills to coordinate complex requirements across clinical and financial disciplines.
Strong working knowledge of Epic for scheduling complex and time-sensitive appointments.

Nice To Haves

Associate degree.
Customer service experience in a hospital or physician office, particularly involving registration, scheduling, medical insurance, and eligibility requirements.

Responsibilities

Obtain required information from referring physicians and clinical providers for submission to third-party payers to support reimbursement for outpatient services.
Accurately schedule patient follow-up physician appointments in the appropriate scheduling system according to system guidelines and requirements.
Enter insurance information accurately and satisfy billing requirements to support payable accounts.
Use online eligibility and insurance systems to review patient eligibility, determine benefits and copayments, and document findings according to departmental policies.
Coordinate patient appointment scheduling, including complex and time-sensitive appointment types using Epic.
Provide support and coverage in other outpatient service departments in collaboration with the Supervisor or Manager, maintaining relevant skills.
Manage time effectively when scheduling patient appointments.
Provide service excellence in accordance with Health System Standards of Professional Behavior and help ensure a positive patient experience.
Receive and acknowledge patients and visitors according to YNHHS Standards of Professional Behavior.
Work with clinical staff to maintain Epic templates for various locations and plan and create scheduling templates for different disciplines.
Review and update training materials as needed and train other staff members.
Perform other duties as assigned by Management.
Make decisions related to medical necessity and follow up with patients or physicians when a Waiver or ABN is required.
Coordinate appointments with appropriate imaging and other satellite locations.