Patient Access Asso Level I

Overview

The Patient Access Associate I will perform duties after an eight week training program under the supervision of the Patient Access Leadership Team and Revenue Cycle Quality & Assurance Training Team. This position is a customer service champion responsible for delivering great customer service at each entry point throughout the health system. This position supports organizational goals by providing high level, quality customer service, participating in performance improvement efforts, demonstrating a commitment to teamwork and cooperation while verifying and preparing all patient accounts for inpatient and outpatient billing in order to maximize payment for Hospital and Clinic services from all sources.

• Responsible for the patient pre-registration, registration, general admissions, and financial assistance processing.
• Be knowledgeable of state and federal government funding programs such as Medicare, Medicaid, TRICARE/CHAMPUS, Workers  Compensation;
  No Fault Auto, and commercial insurance payers.
• Be knowledgeable of billing and reimbursement guidelines and methodologies for state and federal government and non-government payers; insurance terminology; basic medical terminology, EMTALA, HIPAA privacy, and compliance practices.
• Ensure all demographic and insurance information is obtained and correct, and scan IDs and insurance cards as needed. Send query for insurance eligibility information provided by the patient and/or representative to validate eligibility and benefit information and accurately document in the registration system. Inform patient of insurance in/out of network status, as appropriate. Accurately complete the Medicare Secondary Payer Questionnaire on all Medicare eligible patients.
• Verify insurance information through payor contact via telephone, online resources, or electronic verification system.
• Responsible for verifying diagnosis codes and completing medical necessity checks for Medicare. The Patient Access Associate I must have basic knowledge of ICD-10 in order to ensure accurate diagnosis entry for reimbursement.
• Identify and obtain payor authorizations, pre-certifications, and/or referrals. Provide appropriate documentation and follow up to physician offices, case management department, and payors regarding authorization/referral deficiencies. Communicate to service line partners of situations where rescheduling is necessary due to lack of authorization and/or limited benefits and is approved by clinical personnel.
• In working inpatient accounts, be responsible for timely notification to payers of the patient s admission to the facility.
• Identify all patient financial responsibilities, calculate estimates, collect all payments due, including current estimated liabilities, outstanding balances and self-pay deposits, post payment transactions in the system and perform daily reconciliation. Identify self-pay and complex liability calculations and escalate account to Financial Counselors as appropriate. Responsible for all estimates requested for consumer shopper comparison.
• Appropriately collect and/or set payment arrangements with patients or their representatives, schedule payments on deposits due, which may include screening of patients for enrollment in available credit option programs. Document all attempts for collections, using approved verbiage, timely, and consistently. Proactively seek assistance to improve collections.
• Ensure all patients with questions or concerns regarding their bills are referred to the appropriate resource, to include initiation of financial counseling, when appropriate.
• Document pertinent activity on the patient account via notes.
• Maintain a current and thorough knowledge of utilizing online and system tools available, working from manual reports during system downtime.
• The Patient Access Associate I communicates and collaborates with Patient Access team members and other ancillary departments as needed.
• Attend all required training and in-services and pass all competency tests associated with the in-services.
• May be responsible for additional duties as assigned with respect to the Patient Access job scope.

EDUCATION AND EXPERIENCE
:

• High school diploma or equivalent required.
• 0-1 year experience in Healthcare registration or relevant customer service environment required.
• Previous experience in a physicians  office or hospital setting is preferred.
• The Patient Access Associate I can perform job duties based on department procedure and protocol; may require direct oversight

LICENSE/CERTIFICATION:

• Healthcare Financial Management Association - HFMA (CRCR) Certified Revenue Cycle Representative certification required within 120 days of hire or transfer. Current incumbents required to obtain certification by 10/1/2025.

KNOWLEDGE AND SKILLS:

• Ability to communicate effectively both verbally and in writing is sufficient to perform the essential functions; read, understand, and apply policies and guidelines; obtain…