Patient Access Specialist I - Contingent
Saint Joseph Mercy Health System

Employment Type:
Part time
Shift:
Day Shift

Description:
Responsible for the complete and accurate collection of patient demographic and financial information for the purpose of establishing the patient and service specific record for claims processing and maintenance of an accurate electronic medical record. Registers and checks-in patients and determines preliminary patient and insurance liability. Performs routine account analysis and problem solving. Resolves patient account issues. Initiates billing and rebilling of accounts as appropriate. Under limited supervision; determines need for and obtains authorization for treatment /procedures and assignment of benefits required. Provides information to patients concerning regulatory requirements. At point of service, provides estimated costs and patient responsibility, facilitating collection of co-pay, deductible and private pay balances.
Obtains, verifies and enters patient identification, demographic information, and insurance coverage into hospital information system(s), to ensure accurate and timely submission of claims.

Determines visit-specific co-payments and collects out-of-pocket liabilities. Assists patients with questions regarding financial liability or refer to appropriate resource(s).

Inform patients on cost of treatment, insurance benefits, resources for payment and financial assistance.

Secures and documents payment arrangements.

Obtains medical authorization or referral forms, if appropriate.

Audit authorizations for accuracy and determine if delay/deny policy needs to be invoked.

Utilizing key reports and tools to facilitate obtaining accurate insurance information.

Educates patients/families on the use of registration kiosks or online systems. Identifies non-routine complex issues and escalates to Patient Access Lead for resolution.

Assists in the training and education of colleagues upon hire and ongoing as new systems and processes are created.

Maintains compliance with HIPAA and other regulatory requirements throughout all activities. Protects the safety of patient information by verifying patient identity to preserve the integrity of the patient record and ensures all records are complete, accurate, and unique to one patient.

Is proficient at the use of automated tools and makes appropriate decisions related to the relationship of the action required and the tool used. Performs pre-registration and pre-admits.

Communicates frequently with patients/family members/guarantors, and physicians or their office staff in the deployment of key activities.

Interviews patients to collect data, initiates electronic medical records, validates and enters data related to procedures, tests and diagnoses. Determines need for appropriate service authorizations (pre-certifications, third-party authorizations, referrals) and contacts physicians and Case Management/Utilization Review personnel, as needed.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.