Pt Financial Access Specialist

Yale New Haven Health•Branford, 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 collect and update demographic and financial information across computer systems to support timely processing of visits. The specialist acts as a liaison between physicians and patients in arranging internal and external appointments and procedures. Working with patients, physicians, and nursing professionals, the role manages the sequencing of complex procedures, physician appointments, infusion and chemotherapy services, and other multifaceted care. The specialist confirms that patients and physician offices have met required instructions, preparations, and laboratory requirements, coordinates appointments, and maintains patient and insurance demographics to support appropriate reimbursement. The position involves decisions about whether ordered exams meet Medical Necessity requirements and follow-up when a Waiver or ABN is needed. The specialist accounts for imaging and other satellite locations when aligning appointments with patient locations. Accuracy, attention to detail, and patient sensitivity are essential. The role also performs statistical and quality assurance functions, helps develop procedures, and participates in planning, implementing, and training staff on system improvements.

Requirements

High school diploma or GED.
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 as volume fluctuates.
Strong interpersonal skills and ability to build rapport with a wide range of people, including clinical staff.
Excellent investigative, critical-thinking, and problem-solving skills.
Intermediate computer skills and ability to adapt to different programs and systems.
Demonstrated proficiency in understanding registration work queues that affect workflow.
Ability to provide training or in-service sessions to staff and other areas within the department and hospital.
Effective written and oral communication skills, including the ability to communicate complex requirements across clinical and financial disciplines.

Nice To Haves

Associate degree.
Two to three years of work experience in a customer service environment, preferably in a hospital or physician office, with emphasis on registration, scheduling, and medical insurance and eligibility requirements.

Responsibilities

Obtain required information from referring physicians and clinical providers and provide it to third-party payers to support reimbursement for outpatient services.
Schedule patient follow-up physician appointments accurately in the appropriate scheduling system and according to system guidelines.
Enter insurance information accurately to satisfy billing requirements and support payable accounts.
Use online eligibility and insurance systems to assess eligibility, determine benefits and copayments, and document findings according to departmental policies.
Coordinate patient appointment scheduling, including complex and time-sensitive appointment types in Epic.
Provide support and coverage in other outpatient service departments in collaboration with the Supervisor or Manager.
Manage time effectively while scheduling patient appointments.
Provide service excellence and follow Health System Standards of Professional Behavior when assisting patients and visitors.
Work with clinical staff to maintain Epic templates for various locations and disciplines.
Review and update training materials and train other staff members as needed.
Perform other duties assigned by Management.
Make decisions regarding Medical Necessity and follow up with patients or physician offices when a Waiver or ABN is required.
Coordinate complex procedures and appointments, confirm preparation and laboratory requirements, and align appointments with appropriate system locations.
Perform statistical and quality assurance functions and participate in developing procedures and implementing system improvements.