Patient Access Specialist-MGC Ortho. Surg. Eastside

Position Summary

The Patient Access Specialist position receives, coordinates and implements the initial patient experience by providing critical functions essential to ensuring proper clinical treatment, billing and reimbursement, patient satisfaction as well as efficient and accurate handling of the patient registration process.

Minimum Requirements

Education

• High School diploma or equivalency

Experience

• Minimum three years’ experience in healthcare access and/or customer service
• Emphasis on financial analysis of insurance benefits for up front collections
• Focused knowledge with CPT, HCPCS and ICD-10 codes
• Excellent understanding of insurance and medical terminology
• Solid Microsoft Office skills required with a focus on Excel and Word

License/Registration/Certifications

• N/A

Preferred Requirements

Preferred Education

• Associates or bachelor’s degree in Business or Healthcare related field

Preferred Experience

• Minimum four years’ experience in healthcare access, customer service
• Minimum one-year experience in a financial environment

Preferred License/Registration/Certifications

• Certified Healthcare Access Associate (CHAA) or Certified Medical Insurance Specialist (CMIS)

Core Job Responsibilities

• Assists with Onboarding of new associates
• Cross training of current associates

• Comprehensive Pre-Registration process for specified departments/modalities due to sensitive nature of patient clinical and/or financial needs and complication of required processes
• Accurately completes a quality registration in the HIS system that maintains the integrity of demographic and financial information required for clinical and billing functions for every patient encounter
• Understands and adheres to state and federal regulations and system policies regarding compliance, integrity and ethical registration practices.

• Reviews and ensures that all medical orders are compliant and meet government and hospital guidelines as well as clinical protocols
• Completes clinical screening for specified modalities to ensure patient safety
• Ability to obtain insurance eligibility and benefit information from payors via phone, RTE, or web in order to provide patient with estimated responsibility for services requested or rendered

• Responsible for all patient and claim edits for accuracy and compliance with all government and commercial carriers to ensure a clean claim submission
• Works as a liaison with Centralized Referral Center or assigned entity to ensure prior-authorizations have been obtained to secure payment and prevent denials
• Complete and/or process patient payments for account posting accuracy
• Maintain an accurate cash drawer and functions related to cash drawer reconciliation and deposit
• Responsible for practicing AIDET and all customer/patient related encounters
• Performs other duties assigned by department supervisor or manager