Patient Access Specialist I

Patient Access Specialist

The Patient Access Specialist plays a key role in ensuring that patients have timely and efficient access to hospital and service area resources. This position is responsible for processing patient registration information with high accuracy, including collecting demographic and insurance details and performing financial collections.

Key Responsibilities:

• Registration and Information Accuracy: Collect and verify patient demographics, insurance information, and financial details. Ensure all registration data is accurate and complete, facilitating the patient's timely access to services.

• Compliance and Documentation: Prepare and present legal, ethical, and compliance-related documents, ensuring patients understand and complete all required forms during registration. Maintain knowledge of JCAHO standards, Patient Rights and Responsibilities, HIPAA regulations, and payer requirements.

• Mammography Screening Scheduling: Provide scheduling services for mammography screenings, following established protocols for insurance, exam type, patient preferences, and urgency.

• Coordination with Departments: Act as a liaison between Patient Access Services and ancillary departments, facilitating communication and ensuring a smooth flow of information and services for patients.

• Financial Collections: Perform financial collections, including co-pays and deposits at the point of service. Educate patients regarding billing, insurance coverage, and payment options.

• Regulatory Compliance: Adhere to CMS Conditions of Participation, obtaining necessary signatures (ABN, consent forms) as required by CMS regulations.

• Cross-Department Collaboration: Support patient care areas as needed, helping ensure timely and accurate documentation for patient services.

• Other Duties as Assigned: Complete all other duties and special projects as assigned by management to support the department's goals and ensure consistent patient care.

Position Details:

• Shift: Night Shift

• Hours of Shift: 9:45 PM - 6:15 AM

• Weekends: Every Other Weekend

• FTE: 1.0

Qualifications

Education

• High school diploma required

Licensure/Certification/Registry

• Must successfully complete assigned annual education through Healthcare Business Insights

Experience

• Minimum of one (1) year of business office experience, preferably in areas such as Patient Access, billing, collections, insurance principles/practices, or accounts receivable

• Completion of 12 (twelve) hours of coursework in a business or healthcare-related field may be considered in lieu of business office experience

• Previous experience in Patient Access is highly desirable

Knowledge, Skills, and Abilities

• Comprehensive knowledge of tasks performed across various Patient Access Service areas to ensure customer satisfaction and accurate reimbursement

• Excellent interpersonal and patient relations skills, with the ability to maintain emotional composure and exercise sound judgment in all interactions

• Working knowledge of computers, including the ability to enter and retrieve data from registration software and other required applications/systems

• Strong attention to detail, critical thinking, and problem-solving abilities

• Excellent oral and written communication skills, with the ability to maintain professionalism in high-pressure situations

• Flexibility and the ability to exercise judgment and initiative, especially in stressful or rapidly changing environments

• Ability to manage competing priorities independently and effectively

• Strong negotiation and persuasion skills when educating and communicating with patients and families

• Knowledge of medical terminology, medical procedural (CPT), and diagnosis (ICD-10 CM) coding, as well as hospital billing claims is preferred but not required

Responsibilities

• Pre-Registration/Registration: Completes all steps of pre-registration/registration, verifies patient identity and demographic information, and captures health insurance benefit eligibility based on contract/regulatory requirements. Ensures proper consent for patient treatment is obtained.

• Mammography Scheduling: Schedules patients for Mammography procedures according to established protocols, ensuring proper modality, location, insurance requirements, patient preferences, and urgency.

• Billing and Payment Education: Educates patients on billing resolution, private pay options, collection efforts, coordination of benefits, third-party payments, insurance coverage, payments, and denials. Acts as a liaison between external resources and patients for issues requiring SMH involvement.

• Coordination of Financial Documentation: Works with Patient Financial Services, Utilization Management, physicians, and medical offices to maintain consistent financial documentation and interdisciplinary collaboration.

• Regulatory Compliance: Adheres to CMS Conditions of Participation and Section 1154(e) of the Social Security Act, ensuring proper patient signature acquisition. Verifies medical necessity and obtains signatures on Advance Beneficiary Notice of non-coverage (ABN) per CMS regulations.

• Co-Pay and Deposit Collection: Negotiates with patients and families to collect co-pays and/or deposits at the point of service, supporting POS collection goals.

• Financial Assistance Referrals: Triage, document, and refer patients to Medicaid vendors or financial assistance per the Illinois Fair Patient Billing Act and SMH procedures.

• Pre-Authorization/Pre-Certification: Identifies services requiring pre-authorization and works with physicians to meet eligibility requirements prior to service.

• Account Rejection Resolution: Analyzes and resolves rejected accounts from various hospital sources, ensuring verification of patient benefit eligibility and reimbursement from all payer sources, or suitability for financial assistance.

• Staff Training and Coverage: Orients and cross-trains others within the department and provides coverage during staff absences or special needs.

• HIPAA and Regulatory Compliance: Ensures compliance with all HIPAA, Joint Commission, CDC, SMH, and state and federal regulations. Educates patients about Advance Directives, Medicare D coverage, and the grievance process as appropriate.

• Knowledge Maintenance: Maintains up-to-date knowledge of applicable regulations, including the Illinois Fair Patient Billing Act and Illinois Uninsured Patient Discount Act, and completes all required annual organizational education.

• Legal Forms Compliance: Completes Illinois DHS legal forms for psychiatric admits in compliance with state and hospital policies, providing relevant education to patients and families.

• Flexible Work Settings: May rotate between different work settings such as patient registration, bedside registration, or SMH campus environments, and provide coverage for the SMH Financial Lobby Office.

• Productivity and Accuracy: Meets expectations for productivity, accuracy, and point of service collections. Attends quarterly department meetings unless otherwise approved.

• Additional Duties: Performs other related work as assigned.