Patient Access Specialist I

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Now more than ever, our guiding principles are helping us in our search for exceptional talent - candidates who align with our unique workplace culture and who want to maximize the abundant opportunities for growth and success.

If this describes you then let’s talk!

HSS is consistently among the top-ranked hospitals for orthopedics and rheumatology by U.S. News & World Report. As a recipient of the Magnet Award for Nursing Excellence, HSS was the first hospital in New York City to receive the distinguished designation. Whether you are early in your career or an expert in your field, you will find HSS an innovative, supportive and inclusive environment.

Working with colleagues who love what they do and are deeply committed to our Mission, you too can be part of our transformation across the enterprise. Emp Status Regular Full time

Work Shift Day (United States of America)

Compensation Range The base pay scale for this position is $33.20 - $36.94. In addition, this position will be eligible for additional benefits consistent with the role. The salary of the finalist selected for this role will be determined based on various factors, including but not limited to: scope of role, level of experience, education, accomplishments, internal equity, budget, and subject to Fair Market Value evaluation. The hiring range listed is a good faith determination of potential compensation at the time of this job advertisement and may be modified in the future.

What you will be doing

This is a highly visible position responsible for coordinating and securing prior authorizations for medical services and procedures on behalf of the facility and provider, verifying insurance benefits, and communicating with providers, payers, and patients to ensure timely and accurate processing using the Epic system. The Prior Authorization Specialist is a key member of the interdisciplinary team, responsible for managing the end-to-end authorization process to support timely patient access to care. This multifaceted role involves verifying insurance benefits, obtaining approvals for procedures and services through payer portals and Epic, and proactively communicating with providers, patients, and insurance companies. The specialist monitors turnaround times, prevents denials through accurate documentation, and ensures compliance with payer guidelines to optimize patient flow and revenue cycle performance. Daily tasks include obtaining and verifying authorization requirements electronically and by phone, coordinating prior authorizations for procedures, tests, and specialty services, and ensuring documentation accuracy within Epic and payer portals. Responsibilities also include reviewing and resolving work queue encounters, managing patient authorization checklists, and reviewing legal IDs, insurance cards, and signed consent forms when applicable. The specialist determines coverage eligibility, identifies participating vs. non-participating plans, and communicates with clinical team and or patients regarding authorization status and financial responsibility.

Job Qualifications

EDUCATION - Required High School Diploma or equivalent (G.E.D.), may include specialized or vocational courses. EDUCATION – Preferred Associate’s Degree EXPERIENCE – Required 0-1 years experience in a healthcare related field or customer service oriented position. EXPERIENCE – Preferred 2 years in Healthcare/Medical – Working with prior authorizations SKILLS - Required Excellent verbal and written communication skills. Strong customer service orientation. Basic computer skills, with proficiency in office automated tools: e-mail, outlook and data entry. Effective communicator with all levels of staff, patients, clinical team and leadership. Coachable and emotionally controlled. SKILLS - Preferred Working knowledge of medical terminology. Self-directed, motivated, resourceful, demonstrates initiative. Working knowledge of MS Office Suite applications: Word, Excel, Outlook. Proficiency in EPIC Prelude and Cadence Ability to add, subtract, multiply, divide, and calculate percentages Performs accurate typing at 45-60 wpm Multilingual Proficiency in EPIC working with referral-based services. Knowledge of back-end role in revenue cycle: insurance benefits collection, verification, authorization, pre-certification, etc. Ability to respond positively to fluctuations in workflow and email volume. Experience using AI platforms (including natural language processing and machine learning), and ability to interpret and act on AI insights. PHYSICAL WORKING CONDITIONS The role is primarily sedentary, involving extended periods of computer use. ENVIRONMENTAL WORKING CONDITIONS This position operates in a hybrid work environment, with a combination of remote and in-office work. The following conditions apply: Remote Work Environment: The employee is expected to maintain a safe, secure, and ergonomically sound home office setup. Reliable internet access and a distraction-free environment are essential for productivity and confidentiality. Office Environment: When on-site, the employee will work in a standard office setting with controlled climate conditions. POSITION & UNIT ACCOUNTABILITIES – AKA Competencies Complies with policies and procedures concerning infection control and safety in order to maintain a safe and comfortable environment for patients, visitors and staff. Maintains and develops competence through required in-service and continuing educational programs. Manages time appropriately to meet patient, department, and hospital needs. Maintains satisfactory attendance record. Reports for duty punctually. Effectively communicates with various departments and other parties to disseminate and receive information, as requested/required. Recognizes and supports the skills and qualities of others. Demonstrates an understanding of other team members' contributions. Accurately enters all insurance information into the appropriate EMR system. Reviews insurance information on hospital registrations and admissions to ensure accuracy and to optimize patient experience and ensure timely reimbursement. Explains financial requirements to the patient or responsible party and collects deposits, co-payments, deductibles, and other out-of-pocket payments as required.

Answers Epic messages, e-mail, and phone messages promptly and courteously. Accepts constructive criticism and coaching in a positive manner and strives to make personal corrective action a priority. Adjusts to changing situations and work assignments with a positive attitude. undefined Improves performance based on results obtained from QA activities. undefined Attends/participates in staff meetings. When assigned work is completed, offers to assist others or anticipate and prepares for future assignments. Works from assigned patient and account work queues, accomplishes adequate share of team case load to meet individual, unit and department goals. Monitors patient flow in waiting room and communicates with appropriate staff and patients regarding changes and/or disruptions in patient flow. Reports any insurance coverage and /or Managed Care difficulties to departmental leadership, as applicable. Verifies insurance eligibility using Real Time Eligibility system and/or other eligibility tools as required, calls insurance carriers to obtain pre-certifications and / or authorizations and informs patients and clinicians as to patient’s clearance status to ensure the integrity of the revenue cycle and minimize denials. Coordinates benefit’s, revises EMR and notifies patient as appropriate for role. Demonstrates flexibility regarding hours, work assignments and cross coverage to other sections, as needed. Meets departmental performance and quality goals by consistent and accurate data entry; minimizes errors and rework in avoidance of denials. Maximizes efficiency and productivity, consistently meets productivity and quality standards as set by leadership Sets and maintains the highest level of service to patients, clinical team, and other hospital departments. Demonstrates professional and courteous customer services skills by responding timely to patient inquiries. Places customer service first in all aspects of daily functions. Promotes teamwork through cooperation.

Non-Discrimination Policy Hospital for Special Surgery is committed to providing high quality care and skilled, compassionate, reliable service to our community in a safe and healing environment. Consistent with this commitment, Hospital for Special Surgery provides care, admits, and treats patients and provides all services without regard to age, race, color, creed, ethnicity, religion, national origin, culture, language, physical or mental disability, socioeconomic status, veteran or military status, marital status, sex, sexual orientation, gender identity or expression, or any other basis prohibited by federal, state, or local law or by accreditation standards.