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About the Role
The Patient Access Account Specialist I provides basic functions to financially 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. Ensures follow up on authorizations for scheduled and Urgent/Emergent procedures and admissions until date of service or discharge for admissions. 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. 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.
Responsibilities
- 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.
- 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.
Requirements
- 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
- Pass annual competency exam for all areas of responsibility
Skills
- HIPAA
- EMTALA
- CMS guidelines of MSPQ
- EPIC ADT system
Location
- 1100 Central Ave SE Albuquerque, NM 87106-4930
Work Type
- Full time
- Days
Experience Level
- Minimum of 2 years of work experiences in healthcare setting within Patient Access and/or billing plus strong customer service background.
Education Level
- High school diploma
- CHAA, CHAM or other industry equivalent certification preferred
Salary/Compensations
- Minimum Offer $16.38
- Maximum Offer $25.57
Benefits
- Comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
- Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.
About the Company
- Presbyterian exists to improve the health of patients, members, and the communities we serve. We are 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 1600 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.
- We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services
Equal Opportunity
- AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.