Type of Opportunity: Per Required Need FTE: 0.001000 Exempt: No Work Schedule: Varied Days and Hours
Under the direction of the Patient Access Supervisor, the Patient Access Account Specialist I provides basic functions to financial clear patient accounts for government and commercial accounts prior to the date of service. Performs basic financial clearance functions, including insurance verification, authorization, collection and documentation of patient demographics, benefit analysis, and pre-service collections. The Patient Access Account Specialist I will ensure follow up on authorizations for scheduled and Urgent/Emergent procedures and admissions until date of service or discharge for admissions. The Patient Access Account Specialist I must possess a basic knowledge of Medicare (CMS) guidelines, as well as other Compliance Regulatory guidelines applicable to Patient Access to include HIPAA, EMTALA, and CMS guidelines of MSPQ. The Patient Access Account Specialist (PAAS I) monitors work queues for financial clearance and missing authorizations ensuring a payment source is identified and secured and there is a clean claim for billing. The Patient Access Account Specialist I acts as resource to all employees within Patient Access. The Patient Access Account Specialist I is responsible for providing the highest level of customer service to patients, ancillary departments and payers when financially clearing accounts. The PAAS I will work with ancillary departments to ensure the procedures scheduled and authorized meet payer requirements. The Patient Access Account Specialist I provides coverage to other areas and hospitals as needed to minimize overtime and guarantee the patients receive services as needed without registration delays.
Customer Service and Caring Practices:
Achieve exceptional patient experience for patients and patient families by using CARES, AIDET and EPE tools.
Addresses and attempts to appropriately resolve complaints in the moment by using key words at key times and de-escalation processes.
Ability to manage conflict and appropriately request the help of a supervisor when needed.
Implement PROMISE and CARES behaviors in every encounter.
Educates patients for whom they speak regarding insurance benefits and liabilities.
Ensures accounts are financially cleared prior to date of service to alleviate patient concerns over hospital financial matters
Performs the patient registration process. Manage the accurate collection of patient data which includes but is not limited to;
Obtain/confirm and enter demographic and other financial and clinical information necessary for final clearance of scheduled accounts.
Review Urgent/Emergent admission accounts for notification, financial clearance and authorization pre-discharge.
Obtain missing insurance information, to include policy number, group number, date of birth, and insurance phone number if not already identified in account.
Verify insurance for eligibility and benefits using online electronic verification system or by contacting payer directly.
Review and process work queues related to Patient Access pre-visit or urgent/emergent admissions, per department guidelines.
Review of accounts falling within the work queues to ensure the insurance information contains accurate policy ID#s, Group Name and Numbers, Subscriber information, Authorization numbers, as well as correct payer and Coordination of benefits prior to date of service.
Accurately document actions taken in the system of record to drive effective follow-up and ensure an accurate audit trail.
Maintain ongoing knowledge of authorization requirements and payer guidelines. Maintain a proficient knowledge of Medicare (CMS) guidelines as it relates to admissions and outpatient services. Ensuring compliance with admissions forms, benefit entitlement verification, and billing requirements
Ensure accurate completion of MSPQ prior to date of service.
Daily focus on attaining productivity standards; recommend new approaches for enhancing performance and productivity when appropriate.
Monitor and track Data Quality program to ensure errors are corrected prior to final bill and correct accounts as necessary.
Maintain appropriate records, files, and timely and accurate documentation in the system of record.
Work with ancillary departments to ensure coding, diagnosis and facility are authorization are in alignment.
Work with payers to ensure authorization is in place; initiating the auth when appropriate.
Coordinate efforts with Financial Advocates to secure payer source current and future visits.
Monitor work queues to identify late add-on accounts and complete financial clearance procedures prior to services to avoid unauthorized procedures from being performed.
Work with physician offices to resolve discrepancies in authorizations and scheduled procedures.
Collects identified patient financial obligation amounts including residual balance if applicable. Collect liability from patient prior to visit or make arrangements for payment at time of service.
Ensure a payer source has been identified prior to services being rendered.
Ensure authorization for correct procedure (CPT), facility, and date of service is obtained.
Contact patients pre-visit to complete any information missing from the account to ensure accuracy prior to visit.
Transparency with patients through communication of patient liabilities and authorization issue in a timely manner, allowing patients ability to make informed decisions.
Educate patients and answer questions from patients on benefits, liabilities and financial options.
Provide patient with way-finding for appointment at time of pre-registration.
Perform AIDET when speaking to patient to alleviate anxiety and confusion.
Perform assigned patient care responsibilities, which may include but not limited to:
Cooperate fully in all risk management activities and investigations.
Report promptly any suspected or potential violations to laws, regulations, procedures, policies, and practices, and cooperate in related investigation.
Conduct all transactions in compliance with all company policies, procedures, standards, and practices.
Demonstrate knowledge of all applicable compliance and legal requirements of the job based on the scope of practice of the position.
Demonstrates CARES behaviors of Collaborate, be Accountable, Respect, Engage and Serve to all whom you encounter.
Other duties as assigned
High school diploma, continued education preferred
External and Internal Non-Patient Access Candidates: Pass Patient Academy with passing score of 85% or higher
Previous completion and passing of Patient Access Advocate II and III Advancement test.
A minimum of 2 years of work experiences in healthcare setting within Patient Access and/or billing plus strong customer service background.
Strong knowledge and understanding of insurance and financial processing of accounts.
Proficient in EPIC ADT system
Specialty Certifications: CHAA, CHAM or other industry equivalent certification preferred
Pass annual competency exam for all areas of responsibility.
Requires general knowledge of the customer encounter process which may include registration, contract requirements, and coordination of benefits.
Knowledge in Microsoft Office Products.
Benefits are effective day-one (for .45 FTE and above) and include:
Full medical, dental and vision insurance
Flexible spending accounts (FSAs)
Free wellness programs
Paid time off (PTO)
Retirement plans, including matching employer contributions
Continuing education and career development opportunities
Life insurance and short/long term disability programs
About Us Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees.
Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans. We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come. About New Mexico New Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great. Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC. New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
Presbyterian Healthcare Services