Patient Access Specialist at Memorial Health

Overview
Responsible for providing daily staff oversight and assisting with Quality Assurance audits, scheduling, provision of coverage as necessary, on-site training and resolution of patient and staff concerns. This position must excel in all functions performed by Patient Access staff.

Qualifications
Education:
High School or GED required.

Certification:

• Certification through Healthcare Business Insights (HBI) required upon hire and must be maintained every two years.

Must successfully complete assigned annual education through Healthcare Business Insights.

Other Knowledge/Skills/Abilities:

• Knowledge of medical terminology, medical procedural (CPT) and diagnosis (ICD-10 CM) coding, and hospital billing claims, preferred.
• Working knowledge of computers is required with the ability to enter and retrieve data and electronically notate registration software and other required applications/systems.
• Must demonstrate ability to work successfully with internal and external customers.
• Must demonstrate detail orientation, critical thinking and problem solving ability.
• Must demonstrate excellent oral and written communication and customer service skills with ability to maintain a calm and professional demeanor in high stress situation.
• Demonstrated ability to remain flexible and consistently exercise sound judgement and initiative in very stressful situations. Ability to effectively manage competing priorities and work independently in a rapidly changing environment.
• Must demonstrate ability to educate, persuade and negotiate effectively with patients and families.

Demonstrated technical knowledge and proficiency to work in any area of unit responsibility (as assigned) is required.

Responsibilities

1. Distributes work assignments and accommodates work requirements in an efficient and effective manner under the direction of the Patient Access Supervisor and/or Manager.
2. Assists staff as necessary to ensure compliance with department policies and procedures
3. Assists with all aspects of scheduling, including employee call in notifications and management and provision of coverage as necessary.
4. Order and maintain department supplies as defined per budget guidelines and department needs.
5. Assists management with staff onboarding and ongoing training/education.
6. Provide department coverage as appropriate during times of vacancy.
7. Confidentially assists with employee account audits, various report monitoring, and addresses related situations.
8. Reports all staff and patients concerns to PAS Supervisor and may assist with resolution of issues.
9. Responsible for completing all steps of pre-registration/registration; verifies patient identity and demographic information through appropriate tools. Identifies/captures appropriate health insurance benefit eligibility based on contract/regulatory differentiation. Facilitates appropriate billing of claims and hospital reimbursement. Obtains and validates proper consent for patient treatment.
10. Educates patients/others regarding the resolution of billing, private pay options, collection efforts, coordination of benefits, third party and governmental payment criteria, insurance coverage, payments, and denials. May serve as a liaison between external resources and patients on issues requiring MMC involvement.
11. Coordinates with MMC Patient Financial Services, Utilization Management, physicians, and medical offices to ensure consistent financial documentation across the enterprise, and an interdisciplinary approach to patient and organizational needs.
12. Adheres to all CMS conditions of participation regulations regarding delivery, explanation, and acquisition of patient/designated representative signatures on (IM), CMS-R-193, per Medicare Patients' Rights Condition of Participation (CoP) at 42 CFR 482.13(b)(2, and Section 1866(a)(1)(M) and Section 1154(e) of the Social Security Act.
13. Verifies medical necessity, and obtains appropriate signature on Advance Beneficiary Notice of Noncoverage (ABN) per CMS regulations at points of patient access.
14. Effectively negotiates with patients and families to collect and post patient co-pays and/or deposits at point of service. Supports Patient Access Services POS (Point of Service) collection goals as defined by Revenue Cycle leadership and best practice benchmarks.
15. Effectively triages, documents, and may initiate referrals to the Medicaid vendor, submit Medicaid applications for patients, or participate in determination for, and explanation of, MMC's Financial Assistance program, per the Illinois Fair Patient Billing Act, Illinois Uninsured Patient Discount Act, and established MMC procedures.
16. Identifies/reviews services requiring pre-authorization/pre-certification by Medicare, Medicaid, Commercial, and Managed Care payers, to ensure provider eligibility requirements are met prior to receiving service. Utilizes appropriate systems/applications/portals and/or communicates with physician offices as necessary.
17. Analyzes reports containing rejected accounts from a variety of hospital sources, including Non-Patient Access registration departments, and resolves toward verification of patient benefit eligibility, and subsequent reimbursement from all possible payer sources, or determines suitability for financial assistance.
18. Orients and cross-trains others within assigned area of responsibility as directed and defined by management. May assist other areas within the unit or department, as necessary, during times of special needs or staff absences. May be required to work night or weekend shifts.
19. May be required to provide coverage for the MMC Financial Lobby Office when necessary.
20. Demonstrates superior patient relations and interpersonal skills; demonstrates an appropriate level of mental and emotional tolerance and even temperament when dealing with staff, patients and general public, using tact, sensitivity and sound judgment; promotes a positive work environment and contributes to the overall team efforts of the department and organization.
21. Ensures compliance with all applicable HIPAA, Joint Commission, CDC, MMC, and state and federal statues, providing required associated literature to patients at all PAS access points. Educates patients regarding Advance Directives, Medicare D prescription coverage, MMC, Joint Commission, and Illinois Department of Public Health grievance process as appropriate.
22. Maintains current knowledge and complies with the Illinois Fair Patient Billing Act and Illinois Uninsured Patient Discount Act at all times.
23. Completes Illinois DHS legal forms for psychiatric admits, in compliance with State of Illinois and MMC statues and guidelines. Provides relevant patient/family educations.
24. Demonstrates an understanding of medical terminology, procedures and diagnosis necessary to perform appropriate scheduling.
25. Ability to record and understand impact to service of patient's medical history, i.e. allergies, current medications patient's medical history, i.e. allergies, current medications
26. Schedules patients for Mammography procedures efficiently, effectively, and according to established protocol for modality, location, facility capabilities, insurance requirements, type of exam, patient preferences, and urgency.
27. Reviews patient orders against schedule and verifies/correct clinical exam and diagnoses. Communicates changes to clinical team performing service.
28. Track and report daily scheduling and registration metrics
29. May rotate work settings to include various areas of patient registration, bedside registration, or other MMC campus environments.
30. Develops and maintains a comprehensive knowledge of the health system organization and its functions. Completes all assigned annual organizational education
31. Meets expectations for productivity, accuracy, and point of service collections. Consistently meets or exceeds given goals for each area on a monthly basis.
32. Assists in mentoring, training, and development of other Patient Access staff; serves as a resource to staff for questions and problem solving. Demonstrates an advanced understanding of third party payer requirements.
33. Participates in, and/or leads special projects as assigned by management
34. Stays abreast of all applicable knowledge and regulations related to Patient Access and completes mandated educational requirements.
35. Resolves assigned TRAC un-billable/rejected claims edits toward streamlining facility claims processing workflows, reducing reimbursement errors and improving payment integrity.
36. Investigates problematic accounts
37. Assists the Patient Access Managers with planning, developing, and implementing activities within the Patient Access department.
38. May participate in applicant interviews and provide hiring recommendations to management
39. Attendance at quarterly department meetings mandatory unless absence approved by PAS Management prior to meeting date.
40. Performs other related duties as required or assigned.