Patient Access Specialist II

Employment Type: Full time Shift: Day Shift Description: Under limited supervision, the Patient Access Specialist II initiates, obtains, and verifies authorizations for scheduled services based on scheduled procedure and specific treatment protocols. Works in collaboration with clinical areas to determine authorization requirements for scheduled services. Verifies demographic, clinical, financial, and insurance information during the authorization process. Determines liability on patient accounts and works with patients and representatives to identify financial assistance. Accepts point of service payments or provides guidance for payment options and clears the patient for service delivery. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES Provides insurance verification for scheduled services. Communicates with providers, insurance companies, central scheduling and/or clinical staff to obtain referrals or authorization for services. Initiates and/or obtains authorizations for scheduled services. Audits authorizations for accuracy. Estimates out of pocket liabilities for patients based on benefits obtained during the verification process. Provides information and council to patients with regard to authorization/referral status; cost of services/treatments; and insurance benefits to include out of network benefits or non-covered services. Assists patients with identifying financial assistant programs. Secures and documents payments for scheduled services or payment arrangements. Updates and maintains patient records in applicable systems. Performs monthly re-verification activities. Confirms/Audits treatment plan is coded appropriately in the billing system. Stays up to date on insurance guidelines through self-education and seminars as requested. Communicates changes to team leader(s) and manager. Assists in the training and education of Patient Access colleagues upon hire and ongoing as new systems and processes are created. Maintains good rapport and cooperative relationships. Approaches conflict in a constructive manner. Helps to identify problems, offer solutions, and participate in their resolution. Maintains the confidentiality of information acquired pertaining to patient, physicians, colleagues, and visitors to Trinity Health. REQUIRED EDUCATION, EXPERIENCE AND CERTIFICATION/LICENSURE Education: High school diploma or an equivalent combination of education and experience. Associate degree in Accounting or Business Administration highly desired. Experience: Minimum of 2 years' experience in a customer service role with financial responsibilities is required. Experience in health care, insurance, or managed care industries is highly preferred. Experience performing medical claims processing, financial counseling and clearance, or accounting is also highly preferred. REQUIRED SKILLS AND ABILITIES Must be proficient with the core offerings of the Microsoft suite (Word, PowerPoint, Excel). Excellent communication skills both verbal and written. Able to effectively educate and counsel patients and families on complex finance and benefit options. Excellent critical thinking, interpersonal, and problem-solving skills. Must be able to calculate patient liability and exercise judgement when responding to customer questions and concerns. Demonstrates patience in dealing with ordinary, arduous or emotional patients. Excellent data entry and organizational skills. Must be accurate and possess high level of attention to detail. Able to work independently and have good time management skills. High level of initiative. Able to work concurrently on a variety of tasks/projects in a fast-paced environment that is sometimes stressful with individuals that have diverse personalities and work styles. Able to set and organize work priorities and then adapt as business needs change. Able to comprehend and retain information and apply to work procedures to achieve appropriate service delivery. Knowledge of insurance and governmental programs, regulations and billing processes, managed care contracts and coordination of benefits is highly desired. Knowledge of basic accounting principles preferred. Working knowledge of medical terminology, anatomy and physiology, and medical record coding (ICD-10, CPT, HCPCS) is preferred. Our Commitment to Diversity and Inclusion Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law. Trinity Health is one of the largest not-for-profit, faith-based health care systems in the nation. Together, we’re 121,000 colleagues and nearly 36,500 physicians and clinicians caring for diverse communities across 27 states. Nationally recognized for care and experience, our system includes 101 hospitals, 126 continuing care locations, the second largest PACE program in the country, 136 urgent care locations, and many other health and well-being services. Based in Livonia, Michigan, in fiscal year 2023, we invested $1.5 billion in our communities through charity care and other community benefit programs. For more information, visit http://www.trinity-health.org. You can also follow Trinity Health on LinkedIn.