Sr. Patient Access Specialist

The Senior Patient Access Specialist is responsible for performing admitting duties for all patients receiving services at Ensemble Health Partners. Additional duties can include training, scheduling, and other senior-level responsibilities. They are responsible for performing these functions while meeting the mission of Ensemble Health Partners and all regulatory compliance requirements. The Senior Patient Access Specialist will work within the policies and processes that are being performed across the entire organization.

Essential Job Functions:

• Patient Access staff are responsible for assigning accurate MRNs, completing medical necessity or compliance checks, providing proper patient instructions, collecting insurance information, receiving, and processing physician orders while utilizing an overlay tool and providing excellent customer service as measured by Press Ganey. They will serve as the SMART for the department. They are to adhere to Ensemble Health Partners’ policies and provide excellent customer service in these interactions with the appropriate level of compassion. Operates the telephone switchboard to relay incoming, outgoing, and inter-office calls as applicable.

• Patient Access staff are responsible for the utilization of quality auditing and reporting systems to ensure accounts are corrected. These activities may include accounts for other employees, departments, and facilities.

• A Senior Patient Access Specialist is responsible for the development of training materials and programs for new hires to the department, as well as providing continuing education to associates in all areas of the revenue cycle.

• A Senior Patient Access Specialist is responsible for the development of staff schedules within the patient access department.

• A Senior Patient Access Specialist will have on-call responsibilities for the department, including providing after-hours support and guidance. As part of on-call responsibilities, the Senior Patient Access Specialist may be responsible for working unscheduled times to cover staffing issues.

• Senior Patient Access Specialist are responsible for the collection of point of service payments. These activities may be conducted in emergency, outpatient, and inpatient situations including past due balances and offering payment plan options The Patient Access Specialist is expected to adhere to Ensemble Health Partners policies and provide excellent customer service in these interactions. Conducts audits of accounts and assures that all forms are completed accurate, timely to meet audit standards and provides statistical data to Patient Access Leadership. Senior Patient Access Specialists will be held accountable for point of service goals as assigned.

• Explains general consent for treatment forms to the patient/guarantor/legal guardian, obtains necessary signatures and witness’s name. Explains and distributes patient education documents, such as Important Message from Medicare, Observation Forms, Consent forms, and all forms implemented for future services.

• Reviews eligibility responses in insurance verification system and appropriately selects the applicable insurance plan code, enters benefit data into system to support POS (Point of Service Collections) and billing processes to assist with a clean claim rate including pre-registration of patient accounts prior to the patient visit which may include inbound and outbound calls to obtain demographic information, insurance information, and all other patient information.

• Responsible for accurately screening of medical necessity using the Advanced Beneficiary Notice (ABN) software to inform Medicare patients of possible non-payment of test by Medicare and distribution of the ABN as appropriate. Responsible for distribution and documentation of other designated forms and pamphlets.

• This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Associates may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.

Job Experience: 1 to 3 years in a similar role

Other Preferred Knowledge, Skills, and Abilities:

• Understanding of Revenue Cycle including admission, billing, payments, and denials

• Comprehensive knowledge of patient insurance process for obtaining authorizations and benefits verification

• Knowledge of Health Insurance requirements

• Knowledge of medical terminology or CPT or procedure codes

Desired Education Level: Associate degree or equivalent experience

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