Senior Patient Access Specialist

Ensemble Health Partners•Waverly, OH

1d•Onsite

About The Position

Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. The Patient Access Senior Specialist plays a critical role in ensuring a seamless and positive patient experience by accurately managing patient registration and access processes within the healthcare revenue cycle. This role ensures data integrity, regulatory compliance, and a positive patient experience while directly influencing revenue cycle KPIs such as registration accuracy, point-of-service collections, and first-pass claim rates.

Requirements

1 to 3 Years Job Experience
Associate degree or Equivalent Experience Preferred
Understanding of Revenue Cycle including admission, billing, payments, and denials
Comprehensive knowledge of patient insurance process for obtaining authorizations and benefits verification
Knowledge of Health Insurance requirements
Knowledge of medical terminology or CPT or procedure codes
Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences

Responsibilities

Assigning accurate MRNs
Completing medical necessity or compliance checks
Providing proper patient instructions
Collecting insurance information
Receiving and processing physician orders while utilizing an overlay tool
Providing excellent customer service as measured by Press Ganey
Serving as the SMART for the department
Adhering to Ensemble Health Partners’ policies and providing excellent customer service in these interactions with the appropriate level of compassion
Operating the telephone switchboard to relay incoming, outgoing, and inter-office calls as applicable
Utilizing quality auditing and reporting systems to ensure accounts are corrected
Developing training materials and programs for new hires to the department
Providing continuing education to associates in all areas of the revenue cycle
Developing staff schedules within the patient access department
Having on-call responsibilities for the department, including providing after-hours support and guidance
Working unscheduled times to cover staffing issues as part of on-call responsibilities
Collecting point of service payments in emergency, outpatient, and inpatient situations including past due balances and offering payment plan options
Adhering to Ensemble Health Partners policies and provide excellent customer service in these interactions
Conducting audits of accounts and assuring that all forms are completed accurate, timely to meet audit standards
Providing statistical data to Patient Access Leadership
Being held accountable for point of service goals as assigned
Explaining general consent for treatment forms to the patient/guarantor/legal guardian, obtains necessary signatures and witness’s name
Explaining and distributing patient education documents, such as Important Message from Medicare, Observation Forms, Consent forms, and all forms implemented for future services
Reviewing eligibility responses in insurance verification system and appropriately selecting the applicable insurance plan code
Entering benefit data into system to support POS (Point of Service Collections) and billing processes to assist with a clean claim rate including pre-registration of patient accounts prior to the patient visit which may include inbound and outbound calls to obtain demographic information, insurance information, and all other patient information
Accurately screening of medical necessity using the Advanced Beneficiary Notice (ABN) software to inform Medicare patients of possible non-payment of test by Medicare and distribution of the ABN as appropriate
Distributing and documenting other designated forms and pamphlets