Patient Access Account Specialist I-ABQ POSITION CONTROL

phsorg; United States; On-site; USD 23,000 - 35,000; Full time

Job summary

phsorg in Albuquerque, NM is hiring a Patient Access Account Specialist I to perform financial clearance for government and commercial accounts, including insurance verification, eligibility, authorization, and pre-service collections.

Under the supervision of the Patient Access Supervisor, you will manage demographics, review urgent/admission cases for payer compliance, and maintain accurate documentation to ensure smooth billing and patient experience.

Qualifications

• Basic knowledge of Medicare (CMS) guidelines and HIPAA/EMTALA compliance.
• Ability to verify insurance eligibility and benefits.
• Strong customer service and communication skills.

Responsibilities

• Perform patient registration and collect accurate demographic and financial information for final clearance.
• Verify insurance eligibility and benefits using electronic verification or payer contact.
• Obtain missing insurance information (policy number, group number, DOB, phone).
• Review urgent/ emergent admissions for financial clearance and authorization pre-discharge.
• Document actions accurately in the system and maintain audit trails.

Job description

Location Address:
9521 San Mateo NE
Albuquerque, NM 87113-2237

Compensation Pay Range:
Minimum Offer $16.38
Maximum Offer $25.57

Now Hiring: Patient Access Account Specialist I-ABQ POSITION CONTROL

Type of Opportunity: Full time
Job Exempt: No
Job is based: Reverend Hugh Cooper Administrative Center
Work Shift: Weekday Schedule Monday-Friday (United States of America)

Summary

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.

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

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 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 c