Patient Access Account Specialist

Summary:
This position provides all necessary functions to financial clear patient accounts for government and commercial accounts prior to the date of service. Perform all financial clearance functions, including insurance verification, authorization, collection and documentation of patient demographics, benefit analysis, financial counseling, and pre-service collections. Ensure follow up on authorizations for scheduled and Urgent/Emergent procedures and admissions until date of service or discharge for admissions. Must possess a proficient knowledge of Medicare (CMS) guidelines, as well as other Compliance Regulatory guidelines applicable to Patient Access, to include HIPAA, EMTALA and CMS guidelines for MSPQ. Monitor work queues for financial clearance and missing authorizations ensuring a payment source is identified and secured, resulting in a clean claim for billing. Act as the Subject Matter Expert (SME) to all employees within Patient Access and for testing of new or existing software and processes. Is responsible for providing the highest level customer service to patients, ancillary departments, payers and providers when financially clearing accounts. Provide coverage to other areas and hospitals as needed to minimize overtime and guarantee the patients receive services as needed without registration delays. Assist in the shadowing of Patient Access candidates and assist in training new hires.

Type of Opportunity: Full Time
FTE: 1.000000
Exempt: No
Work Schedule: Varied Days and Hours

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Other information:
High School Diploma or GED

Education:
Essential:
* High School Diploma or GED

Responsibilities:
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
*Provides patients with financial options to ensure payer source for visit and allowing patients to make an informed decision.
Encounter Components:
*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 and Urgent/Emergent patient 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 authorized and 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 for current and future visits
*Monitor work queues to identify late add-on accounts, ensuring completion of financial clearance processes prior to services to avoid unauthorized procedures from being performed.
*Work with physician offices to resolve discrepancies in authorization and scheduled procedures.
*Other duties as assigned
Financial Accountabilities:
*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.
*Educate patients on financial assistance, charity or other programs that may be available.
*Refers as appropriate to on site Financial Advocate or to the Financial Advocacy Center
*Ensure payer source is identified prior to services being rendered.
*Ensure authorization for correct procedure code (CPT), facility and date of service is obtained
Patient Relations
*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 regarding benefits, liabilities and financial options.*Provide patient with way-finding for appointment at time of pre-registration
*Perform AIDET when speaking to patients to alleviate anxiety and confusion
Quality Improvement:
*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.
C.A.R.E.S Behaviors:
*Demonstrates CARES behaviors of Collaborate, be Accountable, Respect, Engage and Serve to all whom you encounter.

Other Information
*High school diploma/GED
*Internal Candidates: 4 years experience in healthcare setting with 2 years of Patient Access and/or billing plus strong customer service background. (External: 4 years health care experience with 2 years Patient Access experience).
*Robust knowledge and understanding of insurance and financial processing of accounts.
*Expert knowledge of medical terminology and billing codes (DRG, ICD-10, CPT, HCPCS)
*Proficient in EPIC ADT system
*Requires general knowledge of the customer encounter process which may include scheduling, registration, contract requirements, financial guidelines, and coordination of benefits.
*Knowledge in Microsoft Office Products

We offer more than the standard benefits!

Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more!

Learn more about our employee benefits:

Why work at Presbyterian?

As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. For our employees, we offer a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more.

Presbyterian's story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans.

About Presbyterian Healthcare Services

Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are 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, we are the state's largest private employer with nearly 14,000 employees - including more than 1,600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

About Our Regional Delivery System

Presbyterian's Regional Delivery System is a network of six hospitals and medical centers throughout rural New Mexico including locations in Clovis, Espanola, Ruidoso, Santa Fe, Socorro and Tucumcari. Our regional facilities are home to more than 1,600 clinical and non-clinical employees who help make Presbyterian the state's largest private employer with nearly 14,000 statewide employees. With a variety of services ranging from general surgery to pediatrics to heart and cancer care, our regional employees are proud to provide close-to-home care for their communities.

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 continues to grow steadily in population and features a low cost-of living.

Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture - from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.

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.