Patient Access Specialist - Full Time - Evening

Patient Access Specialist

The Patient Access Specialist is responsible for all Inpatient and Outpatient Patient Access functions within the Patient Access Services Department in their assigned area/hospital(s) at Hackensack Meridian Health (HMH). Conducts quality interviews with every patient to ensure compliance with patient safety rules and state and federal regulations. Gathers appropriate identification for patients and confirms all patient demographics to validate patient identity. Conducts intensive screening of all Medicare, Medicaid and managed care patients to identify network status and coordination of benefits. Obtains all applicable patient consents/attestations. Performs job related functions including, but not limited to, facility based scheduling, bed planning, pre-registration, registration, insurance verification, pre-certification, point of service cash collection and financial clearance under the direction of the Supervisor/Manager/Director for these designated areas. Must adhere to the Medical Center's Quality Standards and maintain a positive patient experience at all times.

Responsibilities include greeting patients and visitors in person/phone in a prompt, courteous, respectful and helpful manner. Implementing the Medical Center's scheduling, pre-registration, pre-certification, referral procurement and insurance verification policies and procedures for the assigned outpatient point of service. Adhering to patient identification policy and ensures an accurate patient search is performed in order to maintain patient safety and prevent duplicate medical record numbers. Checking-in and account for the location and arrival/processing time of patients to ensure prompt service with the established departmental time frames and guidelines. Ensuring Regulatory Forms are filled out and signed by the patient. Performing all functions of bed planning; reservations/pre-registration/bed assignment. Prioritizing bed assignment in accordance with policy. Ensuring patients are assigned to the proper unit according to admit order. Reviewing orders to ensure patient is in appropriate status and level of care. Initiating real time eligibility query (RTE) on all eligible insurances. Must review RTE response to ensure correct plan code assignment and correct coordination of benefits to facilitate timely reimbursement. Ensuring accurate completion of Medicare Secondary Payer Questionnaire. Performing insurance verification on all Inpatient and Outpatient services, and determining the patient's out of pocket responsibility via the EPIC Financial Estimator tool using the applicable data. Where appropriate, pursuing upfront cash collections to assist patients in understanding their financial responsibilities and minimize overall bad debt. Informing patients of their out of pocket responsibility taking payment via credit card or in person and explaining financial resources including financial assistance, payment plans or payment on date of service. Verifying benefits to ensure the procedure is a covered service under the patients plan prior to receiving services. Verifying pre-authorization requirements and following up with both the referring physician and payer to ensure authorizations are on file for the scheduled procedure prior to date of service. Submitting all data timely, effectively and expeditiously for all treatments and procedures to ensure authorizations have been obtained and determine that the procedure or treatment is authorized prior to date of service. Ensuring diagnosis data that is entered on registration is accurate and meets medical necessity criteria. Complying with HMH's patient financial responsibility and collection policies. Providing patients with appropriate administrative information, as directed. Maintaining compliance with federal/state requirements and ensuring signatures are obtained on all required regulatory/consent forms. Manually registering patients accurately when in `downtime' mode and properly following registration input procedures when the system becomes available. Attempting to mediate daily scheduling, pre-registration, pre-certification or registration issues and elevates any issues that cannot be resolved independently. Completing assigned work queue (WQ) accounts in a timely and efficient manner. Assuming other responsibilities as directed by either the Supervisor, Manager or Director of Patient Access. Identifying the needs of the patient population served and modifying and delivering care that is specific to those needs (i.e., age, culture, language, hearing and/or visually impaired, etc.). This process includes communicating with the patient, parent, and/or primary caregiver(s) at their level (developmental/age, educational, literacy, etc.). Ensuring delivery of excellent customer service resulting in a positive patient experience. Complying with all procedural workflows and departmental policies and procedures as identified. Responsible for scanning any documents and correspondence from patients and payers. Coordinating daily activities of the Patient Access Department which fosters an environment promoting patient comfort and trust. Having the ability to schedule patients as needed. Answering a high volume number of phone calls and responding in an appropriate/professional manner. Addressing and resolving any issues quickly/accurately. Ensuring timely notification of admission to payers and referring accounts to Case Management for timely submission of Clinical Information to payer. Verifying eligibility and benefits to ensure patient's coverage is active and that the procedure is a covered service under the patient's plan prior to the date of service. Verifying pre-authorization requirements and following up with both the referring physician's office and payer to ensure authorizations are on file for the scheduled procedure prior to the date of service. Able to access and navigate various payer websites (e.g. Navinet) to confirm patients' insurance coverage and policy benefits. Working with patients to financially clear their account per policy at least 3 days prior to procedure. Resolving any issues with coverage and escalating any complications to supervisor/manager. Making referrals to Financial Counselors if appropriate. Accurate and timely processing of all methods of acceptable payments such as cash/check/money order/credit card transactions. Reconciling daily cash drawer or shift payment transactions, depositing daily cash/check and providing patients with cash receipts, and/or service estimate. Completing a pre-registration on all appropriate patients in Epic. Able to clear a checklist in Epic and set an account status to `Confirmed pre-reg.' Contacting patients and/or physicians' offices in regards to Pre-Admission Testing scheduling in a timely and efficient manner. Obtaining patient records, types and processes scheduling information included but not limited to copying, filing, faxing and answering phone calls in an accurate, efficient and professional manner. Can work in all Access Services areas within the hospital and may rotate shifts as needed. Checking email daily to maintain timely updates on any process/task changes/updates. Meeting departmental daily productivity and process standards. Other duties and/or projects as assigned. Adheres to HMH Organizational competencies and standards of behavior. Lifts a minimum of 20 lbs., pushes and pulls a minimum of 300 lbs., and stands a minimum of 4 hours a day.

Qualifications include Education, Knowledge, Skills and Abilities Required: High School diploma, general equivalency diploma (GED), and/or GED equivalent programs. Ability to work rotating schedules/shifts based on needs. Good written and verbal communication skills. Customer Service Oriented. Basic medical terminology knowledge. Proficient computer skills that may include but are not limited to Microsoft Office and/or Google Suite platforms. Ability to work every other weekend. Ability to work three (3) out of six (6) holidays. Education, Knowledge, Skills and Abilities Preferred: Bachelor's Degree and/or related experience. Minimum of 1+ years of experience in a hospital setting. Patient Financial services experience in a professional or hospital setting. Prior registration/insurance verification experience. Excellent Analytical, written and verbal communication, and interpersonal skills. Proficient medical terminology knowledge. Knowledge of insurance specifications, ICD10 and CPT4 codes. Bilingual (i.e. Spanish or Korean). Experience with EPIC HB, Cadence, and Prelude. Licenses and Certifications Required: Successfully complete EPIC Cadence and Prelude training and pass assessment that follows within 30 days after Network access is granted.