Patient Access Specialist

Inspire Health. Serve With Compassion. Be The Difference.

Receives and interviews patients to collect and verify pertinent demographic and financial data. Verifies insurance and initiates pre-authorization process when required. Collects required payments or makes necessary financial arrangements. Performs all assigned duties in a courteous and professional manner. May perform business office functions.

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference.
• Interviews patient or other source (in accordance with HIPAA Guidelines) to secure information relative to financial status, demographic data and employment information. Enters accurate information into computer database, accesses Sovera to ensure the most recent insurance card is on file, and scans documents according to departmental guidelines. Follows up for incomplete and missing information.
• Verifies insurance coverage/benefits utilizing online eligibility or by telephone inquiry to the employer and/or third-party payor. Information obtained through insurance verification must always be documented in the system. Assigns appropriate insurance plan from the third-party database; ensures insurance priorities are correct based on third-party requirements/ COB. Initiates pre-certification process as required according to Departmental Guidelines; obtains signed waiver for cases where pre-certification is required but not yet obtained.
• Obtains necessary signatures and other information on appropriate forms and documents as required including, but not limited to, Consent Form, Liability Assignment, and Waiver Letter.
• Receives payments and issues receipts, actively working toward collection goals. Maintains cash funds/verification logs and makes daily deposits according to departmental policies and procedures.
• Prepares and distributes appropriate reports, documents, and patient identification items as required. This includes, but is not limited to, Privacy Notice, Patient Rights and Responsibilities, Patient Rights in Healthcare Decisions Brochure, Medicare Booklet, schedules, productivity logs, monthly collection reports, patient armbands, patient valuables, etc.
• Communicates to patients their estimated financial responsibility. Requests payment prior to or at the time of service. Refers patients who may need extended terms to the Medical Services Payment Program and patients needing financial assistance to appropriate program.
• Performs other duties as assigned.

Supervisory/Management Responsibilities

• This is a non-management job that will report to a supervisor, manager, director, or executive.

Minimum Requirements

• Education - High School diploma or equivalent OR post-high school diploma/highest degree earned
• Experience - Two (2) years of Admissions, Billing, Collections, Insurance and/or Customer Service

Knowledge, Skills and Abilities

• Basic computer skills (word processing, spreadsheets, database, data entry)
• Mathematical skills
• Registration and scheduling experience preferred
• Familiarity with medical terminology preferred

Work Shift: Day (United States of America)

Location: Tuomey

Facility: Tuomey Hospital

Department: Outpatient Rehabilitative Services Admin

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.