Patient Access Spec III - WMCG - Augusta Georgia

Patient Access Specialist III

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

The Patient Access Specialist III is responsible for scheduling outpatient procedures, gathering patient, guarantor, and insurance information, and entering the information in the health information system. The Patient Access Specialist III Schedistrar I manages scheduling requests from both patients and physician offices via phone, fax, paper requisition, and other acceptable forms of communication. The Patient Access Specialist III also provides visit-specific information to patients in preparation for their scheduled services and answers and triages patient questions and requests. Changing business needs can necessitate changes in work responsibilities.

Core Responsibilities and Essential Functions:

• Schedule outpatient procedures for departments within the sphere of responsibility.
• Perform registration functions including gathering basic demographic, guarantor, and insurance information during a single phone call in order to reduce wait times and simplify the check-in process.
• Enters all patient information into the registration system.
• Obtains all necessary signatures and is knowledgeable regarding any special forms that may be required by the patients third-party payer.
• Respond to both written and verbal request to have appointments rescheduled or canceled.
• Utilize medical terminology knowledge to determine if appointment request is consistent with the order.
• Inform patients and providers that a necessary authorization has not been obtained or that a procedure is being flagged as not medically necessary and that the patient may need to sign a non- covered services waiver upon arrival.
• Provide price estimates or triage requests to the appropriate resource when patients request information on their expected out-of-pocket expenses.
• Triage and process Appointment Requests adhering to department standards and communicating accurate, pertinent information to care providers and other members of the healthcare team.
• Identify, report, and prevent the creation of duplicate patient records, billing accounts and/or medical records to ensure patient safety and satisfaction. Efficiently use multiple information systems as required by departmental workflows.
• Answer basic Financial questions and refer patients to PFS when unsure how to respond to customer inquiries.
• Read, review and operationalize federal regulations regarding Advance Directives, COBRA, Medicare, Corporate Compliance, Joint Commission, OSHA and HIPAA; report safety and customer concerns to management.
• Read, review and operationalize new/revised policies/procedures via email, postings, mailings, voice mail and meetings.
• Utilize free time to ensure all activities benefit the department.
• Perform other duties and responsibilities as assigned.
• Reviews and monitors all order transcriptions and scanning.
• Assists with missing diagnostic and pathology reports.
• Assists in onboarding new team members.
• Assists with Coordination of Care Medical Record Requests.
• Floats to other locations as needed to provide needed support.
• The PAS III, Schedistrar I serves as a department preceptor and mentor and as such must:
• Maintain a registration accuracy rate or higher in the past 12 months.
• Maintain minimum productivity requirements.
• Has no corrective disciplinary action during the past twelve (12) months.
• Willing and able to function as a preceptor in the orientation of new patient access personnel and students.
• Maintain required certifications by obtaining necessary CEUs and submitting timely to certifying board.
• Budget/Financial:
• Attempts to collect the estimated self-pay balance of all inpatient, outpatient and ER accounts, at the earliest possible collection control point.
• Monitors in-house accounts and attempts to make financial arrangements with guarantors for payment of their self-pay balances in full and prior to discharge.
• Completes financial evaluation forms to document guarantors' income, expenses, assets and liabilities.
• Identifies those patients without adequate insurance coverage. Makes personal contact with patient or guarantor to determine guarantor's ability to pay non-covered charges, as well as to determine potential eligibility for financial assistance programs (namely Medicaid).
• Maintains a list of health care financial assistance programs and the eligibility requirements for each program. Refers patients/guarantors to sources of outside funding assistance, as needed.
• Works efficiently and accurately within designated time frames to ensure a continuity of information and cash flow.
• Contacts scheduled patients at home to obtain pre-admission information, explain financial policies, estimate self-pay balances, and obtain a promise to pay on or before admission/registration.
• Interviews all inpatients and select (self-pay) outpatients at time of registration, or at least within 24 hours of admission, to verify complete insurance and financial information, explain financial policies, and collect the estimated self-pay balance.
• Documents concise and understandable notes regarding all self-pay account collection activity, as well as each patient or guarantor interaction. Documents all efforts to collect patient account balances, other self-pay collection activities and referrals to Medicaid.
• Coordinates financial counseling activities with Admitting, Outpatient Registration, Emergency Registration, Utilization Review, Nursing, Social Services, and Patient Financial Services.
• Verifies insurance coverage and benefits.
• Exceeds monthly quota on a consistent basis. Formally reports results of self-pay collection activity to direct supervisor, on a daily basis or according to policy. Provides feedback to PAS management concerning self-pay collection and data integrity issues.
• Responsible for completion of appropriate error/issues in WorkQueues.
• Identifies and resolves Payor Denials as indicated.
• Customer Service:
• Greets all guest with a positive and professional attitude.
• Receives patients valuables for safekeeping in the hospital safe.
• Answers incoming phone calls and follows through with requests made.
• Maintains courteous and cooperative working relationships with WHS management, patients, physicians, other professional contacts, and the general public. Demonstrates ability to tactfully handle difficult situations.
• Presents a well-groomed and professional image in coordination with dept/ hospital dress codes.
• Expected Performance, Behaviors and Results:
• The WellStar Experience (Must demonstrate a commitment to Service Excellence by):
• Creating first impressions, memorable moments and impressions that fulfill the expressed and unexpressed wishes and needs of patients and family members.
• Valuing patients and family members as partners in their care.
• Having world-class processes in place.
• Delivering high-touch care that is reliable, responsive and coordinated.
• Focusing on constant innovation and creating improvements.
• Celebrating our diversity with sensitivity and understanding.
• Embracing the idea that we are all owners of our health system.
• General:
• Observes work hours and provides proper notice of absences, tardies work schedule changes.
• Attends select departmental meetings at the request of WHS Management.
• Completes monthly, quarterly, and annual mandatory training as required.
• Performs other duties as assigned.
• Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Required Minimum Education:

High School Diploma General or GED General or Associates General-Preferred

Required Minimum License(s) and Certification(s):

All certifications are required upon hire unless otherwise stated.

• CHAA - Cert Healthcare Access Assoc or CPAR - Certified Patient Account Rep or CRCR - Certified Revenue Cycle Rep or CRCR-P - Certified Revenue Cycle Rep - Provisional (90 Days) within 120 Days

Additional License(s) and Certification(s):

Required Minimum Experience:

Must possess at least one year of healthcare experience in Patient Access Services, Practice Operations, or Patient Financial Services Required and Bachelors degree or higher may substitute for experience. Required

Required Minimum Skills:

Effective communication skills (both written and verbal) with the ability to communicate with various members of the healthcare team. High attention to detail, self-directed and a positive attitude are essential. Effective problem solving and critical thinking skills. Typing or data entry competency of at least 40 words/minute. Cash handling and balancing. Demonstrated professionalism