Patient Access Specialist I

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Work Shift: Day (United States of America)

Job Summary:

This job is typically the first point of contact and must ensure a pleasant experience for patients and visitors. Interviews patients and/or their representatives to obtain complete and accurate demographic, financial and insurance information, required for billing and collecting patient accounts. Conducts intensive screening of all Medicare, Medicaid and managed care patients for pre-certification requirements and provider service eligibility, prior to registration. Obtains all necessary customer consents/attestations. Coordinates the collection of all estimated patient liabilities, including co-payments and unmet deductibles. Verifies insurance benefits and coverage for inpatients and outpatients. Responds to customer requests and answers questions regarding various service and account information. Analyzes and rectifies customer concerns using established procedures. Uses computer to access and/or update customer records. Verifies and posts transactions. Follows established procedures for processing receipts, cash etc. Sorts and files various documents. Assists with general hospital information and directions to departments within and outside of the WHS facility. Establishes financial arrangements to reduce financial risk for WHS, helping to ensure that WellStar is reimbursed for its services.

Core Responsibilities and Essential Functions:

Quality/Safety: Receives requests for reservations (patient scheduling) from physicians offices and makes the necessary pre-admission arrangements, referring to lists of dates allotted for scheduling, and advising physicians office staff of unavailable dates. Interviews each patient or representatives to obtain complete and accurate demographic, financial and insurance information. 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. Reads physicians orders to determine the procedures requested and to instruct patients accordingly. Escorts or arranges to have patient escorted to procedure areas and assigned rooms. Makes corrections and updates patient account information in computer. Obtains new medical record numbers for newborn admissions and other new patients. Documents thorough explanatory notes on patient accounts, concerning any non-routine circumstances, clarifying special billing processes. Maintains a working knowledge of available information system capabilities and performs all system applications that are required. Understands and applies WHS philosophy and objectives, and PAS policies and procedures, as related to assigned duties. Understands the admission, outpatient and emergency registration process. Maintains confidentiality of patient information, in accordance with WHS policy and HIPPA regulations. Consistently demonstrates the ability to organize work, recognizes and establishes appropriate work priorities, and completes work in a productive manner, without creating backlogs. Maintains proficiency in data entry skills. Assists physicians and their office staff to expedite scheduling, pre-admission, Medicaid screening and pre-certifications on all accounts. Resolves error and applicable Claim, DNB, and Patient WorkQueues.

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.

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, prior to discharge, or within ten working days thereafter. 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.

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:

• GED General or High School Diploma 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:

Minimum 1 year in healthcare, or institutional (corporate) work setting Required

Required Minimum Skills:

Computer/data entry experience. Ability to communicate with various members of the healthcare team. Effective communication skills (both written and verbal), attention to detail, self-directed and a positive attitude are essential. Effective problem solving and critical thinking skills. Working knowledge of patient registration systems and intermediate Microsoft Office Suite are preferred. Epic experience preferred. Patient Access Services (PAS) Operations Onboarding Training followed by a minimum passing score of on final exam within 45 days of hire. Staff who do not pass will no longer meet the minimum requirement and will subsequently have the option to meet with the Talent Acquisition Specialist to assess other positions available within the health system. PAS employees who successfully complete the PAS onboarding exam will have the option to progress through enrollment to the WHS Enterprise Membership - HFMA Certification program, subject to PAS leadership approval

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