Senior Patient Access Specialist

Ensemble Health Partners•Lexington, KY

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 company recognizes that healthcare requires a human touch and believes that every touch should be meaningful, making their people the most important part of who they are. By empowering associates to challenge the status quo, they aim to make a difference. Ensemble's O.N.E Purpose includes Customer Obsession (providing exceptional experiences), Embracing New Ideas (continuously innovating with technology), and Striving for Excellence (delivering outstanding results). 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
Equivalent Experience
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

Nice To Haves

Associate degree

Responsibilities

Assign accurate MRNs
Complete medical necessity or compliance checks
Provide proper patient instructions
Collect insurance information
Receive and process physician orders while utilizing an overlay tool
Provide excellent customer service as measured by Press Ganey
Serve as the SMART for the department
Adhere to Ensemble Health Partners’ policies and provide excellent customer service with the appropriate level of compassion
Operate the telephone switchboard to relay incoming, outgoing, and inter-office calls as applicable
Utilize quality auditing and reporting systems to ensure accounts are corrected, including accounts for other employees, departments, and facilities
Develop training materials and programs for new hires to the department
Provide continuing education to associates in all areas of the revenue cycle
Develop staff schedules within the patient access department
Have on-call responsibilities for the department, including providing after-hours support and guidance
Work unscheduled times to cover staffing issues as part of on-call responsibilities
Collect point of service payments in emergency, outpatient, and inpatient situations, including past due balances and offering payment plan options
Adhere to Ensemble Health Partners policies and provide excellent customer service in these interactions
Conduct audits of accounts and assure that all forms are completed accurate, timely to meet audit standards
Provide statistical data to Patient Access Leadership
Be held accountable for point of service goals as assigned
Explain general consent for treatment forms to the patient/guarantor/legal guardian, obtain necessary signatures and witness’s name
Explain and distribute patient education documents, such as Important Message from Medicare, Observation Forms, Consent forms, and all forms implemented for future services
Review eligibility responses in insurance verification system and appropriately select the applicable insurance plan code
Enter benefit data into system to support POS (Point of Service Collections) and billing processes to assist with a clean claim rate
Pre-register 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 screen 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
Distribute and document other designated forms and pamphlets
Perform other job-related duties as required by their supervisor, subject to reasonable accommodation