PATIENT ACCESS CENTER SPECIALIST

JOB SUMMARY

Works under the supervision of the Patient Access Center (PAC) Coordinator and CCMG Directors, the Patient Access Center Specialist performs detailed, accurate registration, eligibility verification, and scheduling of all applicable patients to assure smooth workflow and productivity for staff and providers. Answers and routes phone calls appropriately, addressing inbound and outbound patient referrals, pre-certifying patients, and confirming patient appointments. Maintains the integrity of the demographic information of the patient, insured, guarantor and insurance company. Displays professionalism and high-quality customer service during all patient encounters. Performs other duties as assigned.

PRIMARY JOB DUTIES

• Ensures superior ongoing patient satisfaction and customer service.
• Exercises effective problem-solving skills.
• Demonstrates efficient time management and prioritization skills.
• Is proficient in EHR applications.
• Answers all incoming calls, responds timely and professionally to callers.
• Collaborates with CCMG clinics, community clinics, and hospital departments as necessary in order to schedule patients, complete pre-certifications, verify eligibility, complete inbound and outbound referrals, and route calls.
• Functions as a central communication source for the clinic, patients, and external sources – screens and routes incoming calls appropriately.
• Exhibits pleasant interpersonal skills in greeting patients on telephone.
• Accurate interview and registration of new patients as well as updating demographic and insurance information on established patients.
• Coordinates pre-certification and verification processes with insurance companies for CCMG patients.
• Accurate input of demographic, guarantor and insurance information into EHR.
• Obtains signature(s) of patient and/or responsible parties on consent, insurance and payment policies and procedures.
• Communicates to the patients the details of consents, filing of insurance, and payment of services. Assists patients in understanding billing and collection of payment.
• Collects and scans insurance cards or completed insurance forms from patients.
• Maintains a thorough knowledge of CCMG PAC policies as well as third-party private insurance reimbursement procedures and coverage so that pre-certifications can be performed accurately/timely.
• Identifies, follows up and secures missing (and incorrect) patient and insured party information for clean claim processing.
• Scheduling patients for office appointments, maintaining parameters of provider schedules and following clinic standards and guidelines.
• Verifies Insurance eligibility for all patient appointments two days prior to appointment in order to call and obtain updated information from the patient prior to at the minimum upon arrival of their appointment.
• Collects payment/co-payment and deposits from patients as appropriate or refers patient to Patient Accounting to make standard payment arrangements.
• Operates all office machines properly.
• Makes appointment reminder calls.
• Destroys confidential information per HIPAA guidelines.
• Secures confidential items nightly, including EHR, paper Medical Records.
• Maintains phone system including message retrieval, and controls day and night mode functions.
• Participates in cross-training.
• Adheres to CCMH and Campbell County Clinic policies and procedures.
• Maintains confidentiality of all personnel and patient care and relations information.
• Actively participates in Customer/Guest Relations and Mandatory Education programs.
• Follow hospital and departmental policies and procedures.
• Must be free from governmental sanctions involving health care and/or financial practices.
• Complies with the hospital’s Corporate Compliance Program including, but not limited to, the Code of Conduct, laws and regulations, and hospital policies and procedures.
• Performs other duties as assigned.

JOB SPECIFICATIONS

• Education
  • High school diploma or GED required.
• Licensure
  • None
• Experience
  • Experience in Healthcare related field preferred
  • Prior customer relations experience preferred
  • Prior computer keyboarding and 10-key calculator experience preferred
  • Medical terminology knowledge preferred
  • Prior hospital/medical billing experience preferred.