Senior Patient Access Specialist

Job Summary

Required Qualifications

• •Associate degree or equivalent experience
• •1 to 3 years in a similar position
• •Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences
• •Must be able to work on-site at Tower - Pottstown Hospital in Pottstown, PA
• •Available for Full Time Hours: 2pm - 11pm, Monday thru Friday, On-Call rotation, Holiday Rotation
• •Responsible for performing admitting duties for all patients receiving services at Ensemble Health Partners
• •Responsible for assigning accurate MRNs
• •Responsible for completing medical necessity or compliance checks
• •Responsible for providing proper patient instructions
• •Responsible for collecting insurance information
• •Responsible for receiving, and processing physician order while utilizing an overlay tool
• •Responsible for providing excellent customer service as measured by Press Ganey
• •Responsible for operating the telephone switchboard to relay incoming, outgoing, and inter-office calls as applicable
• •Responsible for the utilization of quality auditing and reporting systems to ensure accounts are corrected
• •Responsible for the development of training materials and programs for new hires to the department
• •Responsible for providing continuing education to associates in all areas of the revenue cycle
• •Responsible for the development of staff schedules within the patient access department
• •Responsible for on-call responsibilities for the department, including providing after-hours support and guidance
• •Responsible for working unscheduled times to cover staffing issues
• •Responsible for the collection of point of service payments
• •Responsible for conducting audits of accounts and assuring that all forms are completed accurate, timely to meet audit standards
• •Responsible for providing statistical data to Patient Access Leadership
• •Responsible for explaining general consent for treatment forms to the patient/guarantor/legal guardian
• •Responsible for obtaining necessary signatures and witness's name
• •Responsible for explaining and distributing patient education documents, such as Important Message from Medicare, Observation Forms, Consent forms, and all forms implemented for future services
• •Responsible for reviewing eligibility responses in insurance verification system
• •Responsible for appropriately selecting the applicable insurance plan code
• •Responsible for entering benefit data into system to support POS (Point of Service Collections) and billing processes
• •Responsible for assisting with a clean claim rate
• •Responsible for pre-registration of patient accounts prior to the patient visit
• •Responsible for obtaining inbound and outbound calls to obtain demographic information, insurance information, and all other patient information
• •Responsible for accurately screening of medical necessity using the Advanced Beneficiary Notice (ABN) software
• •Responsible for informing Medicare patients of possible non-payment of test by Medicare
• •Responsible for distribution of the ABN as appropriate
• •Responsible for distribution and documentation of other designated forms and pamphlets
• •Responsible for adhering to Ensemble Health Partners policies
• •Responsible for providing excellent customer service in these interactions with the appropriate level of compassion

Desired Qualifications

• •Understanding of Revenue Cycle including admission, billing, payments, and denials
• •Comprehensive knowledge of patient insurance process for obtaining authorizations and benefits verification
• •Knowledge of Health Insurance requirements
• •Knowledge of medical terminology or CPT or procedure codes