Patient Access Specialist - Full Time - Day

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

• Greets patients and visitors in person/phone in a prompt, courteous, respectful and helpful manner.
• Implements the Medical Center's scheduling, pre-registration, pre-certification, referral procurement and insurance verification policies and procedures for the assigned outpatient point of service.
• Adheres to patient identification policy and ensures an accurate patient search is performed in order to maintain patient safety and prevent duplicate medical record numbers.
• Check-in and account for the location and arrival/processing time of patients to ensure prompt service with the established departmental time frames and guidelines.
• Ensures Regulatory Forms are filled out and signed by the patient.
• Performs all functions of bed planning; reservations/pre-registration/bed assignment.
• Prioritizes bed assignment in accordance with policy.
• Ensures patients are assigned to the proper unit according to admit order.
• Reviews orders to ensure patient is in appropriate status and level of care.
• Initiate 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.
• Ensure accurate completion of Medicare Secondary Payer Questionnaire.
• Performs insurance verification on all Inpatient and Outpatient services, and determines the patient's out of pocket responsibility via the EPIC Financial Estimator tool using the applicable data.
• Where appropriate, pursues upfront cash collections to assist patients in understanding their financial responsibilities and minimize overall bad debt.
• Informs 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.
• Verifies benefits to ensure the procedure is a covered service under the patients plan prior to receiving services.
• Verifies pre-authorization requirements and follows up with both the referring physician and payer to ensure authorizations are on file for the scheduled procedure prior to date of service.
• Submits 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.
• Ensures diagnosis data that is entered on registration is accurate and meets medical necessity criteria.
• Complies with HMH's patient financial responsibility and collection policies.
• Provides patients with appropriate administrative information, as directed.
• Maintains compliance with federal/state requirements and ensures signatures are obtained on all required regulatory/consent forms.
• Manually registers patients accurately when in `downtime' mode and properly follows registration input procedures when the system becomes available.
• Attempts to mediate daily scheduling, pre-registration, pre-certification or registration issues and elevates any issues that cannot be resolved independently.
• Completes assigned work queue (WQ) accounts in a timely and efficient manner.
• Assumes other responsibilities as directed by either the Supervisor, Manager or Director of Patient Access.
• Identifies the needs of the patient population served and modifies and delivers 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.).
• Ensures delivery of excellent customer service resulting in a positive patient experience.
• Complies with all procedural workflows and departmental policies and procedures as identified.
• Responsible for scanning any documents and correspondence from patients and payers.
• Coordinates daily activities of the Patient Access Department which fosters an environment promoting patient comfort and trust.
• Have the ability to schedule patients as needed.
• Answers a high volume number of phone calls and responds in an appropriate/professional manner. Address and resolve any issues quickly/accurately.
• Ensures timely notification of admission to payers and refers accounts to Case Management for timely submission of Clinical Information to payer.
• Verifies 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.
• Verifies pre-authorization requirements and follows 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.
• Works with patients to financially clear their account per policy at least 3 days prior to procedure. Resolves any issues with coverage and escalates any complications to supervisor/manager. Makes 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.
• Completes 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.'
• Contacts patients and/or physicians' offices in regards to Pre-Admission Testing scheduling in a timely and efficient manner.
• Obtains 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.
• Checks email daily to maintain timely updates on any process/task changes/updates.
• Meet departmental daily productivity and process standards.
• Other duties and/or projects as assigned.
• Adheres to HMH Organizational competencies and standards of behavior.

Qualifications

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.