Patient Access Lead, Financial Counseling & Self Pay

Job Type


Full-time

Description

Under the direction of the Supervisor of Patient Access, Financial Counseling & Self-Pay, the Lead Patient Access & Financial Counseling Specialist serves as a senior-level team member responsible for supporting daily front-end revenue cycle operations within the Critical Access Hospital (CAH) and associated clinics.

This position functions as a working lead, providing advanced registration, insurance verification, financial counseling, and self-pay support while assisting the Supervisor with daily operations, payroll coordination, quality monitoring, reporting, training, and departmental projects.

The Lead ensures accurate and timely patient registration, insurance verification, authorization compliance, estimation delivery, and point-of-service collections while serving as a subject matter expert in Cerner CommunityWorks and related revenue cycle systems.

Operational Support & Workflow Coordination

• Serve as a senior-level resource for Patient Access, Financial Counseling, and Self-Pay staff.
• Provide day-to-day guidance to Patient Access staff and assist in prioritizing workflow to ensure timely completion of registrations, verifications, and financial counseling activities.
• Assist the Supervisor with daily workflow coordination, staffing coverage, and schedule adjustments.
• Support payroll preparation, timecard review, PTO tracking, and productivity monitoring.
• Provide lunch and absence coverage to maintain uninterrupted front-end operations.
• Assist with onboarding and training of new staff members.

Advanced Registration & Financial Counseling Functions

• Perform all Patient Access Representative duties at an advanced level.
• Complete complex registrations including multi-payer accounts, accident claims, Medicare Secondary Payer (MSP) situations, and specialty billing scenarios.
• Provide patient liability estimates using hospital estimation tools and ensure compliance with Price Transparency and Good Faith Estimate (GFE) requirements.
• Assist patients with payment plans, financial assistance applications, and self-pay processes.
• Ensure point-of-service collections of co-pays, deductibles, coinsurance, and self-pay balances in accordance with hospital policies.
• Identify and resolve registration-related errors that may impact billing accuracy and reimbursement.

Quality Assurance & Revenue Integrity

• Perform daily and weekly registration quality audits.
• Review Cerner CommunityWorks reports including registration quality, missed MSP questionnaires, skipped Medicare questionnaires, invalid orders, and pending registrations.
• Identify trends in registration errors and provide corrective education to staff.
• Assist with denial prevention efforts related to front-end registration and authorization processes.
• Monitor insurance verification accuracy using Experian and SSI tools.
• Ensure documentation supports clean claim submission and accurate billing.

Systems & Reporting (Cerner CommunityWorks Super-User)

• Maintain advanced proficiency in Cerner CommunityWorks registration workflows.
• Assist the Supervisor with system configuration support including payer maintenance and workflow updates.
• Troubleshoot registration and eligibility workflow issues and assist staff with system navigation.
• Support Experian eligibility verification tools and portal processes.
• Generate and compile operational reports as requested by the Supervisor or Director.
• Participate in system upgrades, testing, and workflow optimization initiatives.

Compliance & Regulatory Support

• Maintain compliance with all applicable regulations and standards including HIPAA Privacy and Security regulations
• EMTALA: requirements
• Medicare: Secondary Payer (MSP) regulations
• Price: Transparency and Good Faith Estimate (GFE) requirements
• Federal, state, and payer-specific guidelines
• Ensure proper documentation of physician orders and authorizations.
• Assist in maintaining and updating departmental Standard Operating Procedures (SOPs).
• Support Joint Commission readiness and regulatory compliance activities.

Communication & Collaboration

• Collaborate with Patient Accounting, Clinical Departments, Clinics, and Revenue Cycle teams to ensure smooth patient access and billing processes.
• Participate in department meetings, huddles, and operational discussions as assigned.
• Assist the Supervisor in preparing information for committee reporting including Denials Committee, Patient Access Committee, and Swing Bed Committee.
• Promote a professional, service-driven, and patient-focused environment.

Requirements

EDUCATION / EXPERIENCE REQUIRED •

• High School Diploma or GED required.
• Associate's or Bachelor's Degree in healthcare administration, business, or related field preferred.
• Minimum of two (2) years of Patient Access or Financial Counseling experience required.
• Demonstrated advanced knowledge of Insurance eligibility and verification Medicare, Medicaid, and commercial payers
• Prior authorization processes
• Self-pay and financial assistance workflows
• Experience with Cerner CommunityWorks required.
• Experian experience preferred.
• Strong analytical, organizational, and problem-solving skills.
• Proficiency in Microsoft Word, Excel, and reporting tools.