Patient Access Advocate II-ABQ

Presbyterian Healthcare Services; United States; On-site; USD 23,000 - 34,000; Full time

Job summary

Presbyterian Healthcare Services is hiring a Patient Access Advocate II in Albuquerque, NM to register patients, verify insurance, obtain authorizations, and analyze benefits for accurate, timely billing. You will support government and commercial accounts with strong customer service at the point of service.

Responsibilities include CARES/AIDET/EPE-based patient interactions, complaint resolution, insurance education, and ensuring financial clearance at the time of service.

Qualifications

• High school diploma or GED required.
• 1 year of work experience in Patient Access and/or billing with strong customer service background.
• Completion and passing of Patient Access Advocate II Advancement test.
• CHAA, CHAM or other industry certification preferred.
• Strong understanding of insurance and financial processing of accounts.
• Basic understanding of medical terminology and billing codes (DRG, ICD-10, CPT, HCPCS).
• Proficient in EPIC ADT system.
• Strong keyboarding/data entry skills and attention to accuracy.

Responsibilities

• Provide exceptional patient experience using CARES, AIDET and EPE tools.
• Resolve complaints in the moment using de-escalation and key words.
• Manage conflicts and escalate to supervisor when needed.
• Educate patients on insurance benefits and liabilities.
• Ensure accounts are financially cleared at time of service through account review.
• Maintain documentation and audit trails in system of record.

Skills

Communication skills

Attention to detail

Problem solving

Multitasking

Education

High school diploma or GED

Tools

EPIC ADT system

Job description

Location Address: 1100 Central Ave SE Albuquerque, NM 87106-4930 Compensation Pay Range: Minimum Offer $16.37 Maximum Offer $24.89 Now Hiring: Patient Access Advocate II-ABQ

Summary:

The Patient Access Advocate II provides registration of patient accounts for government and commercial accounts on date of service for scheduled and unscheduled visits. Perform registration functions, including updating of demographics, insurance verification, authorizations, collection of point of service liabilities and documentation of benefit analysis and registration information within the ADT system. Confirm and follow up on authorization for scheduled visits and make certain account being registered has accurate information to ensure clean billing. Provide coverage to other areas as needed to minimize overtime and guarantee the patients receive services as needed without registration delays. Must possess a strong knowledge of Medicare (CMS) guidelines, as well as other Compliance Regulatory guidelines applicable to Patient Access. Monitor accounts to identify any duplications and correct prior to patient receiving services to ensure patient safety. Provide the highest level of customer service to patients/family at time of service through registration interactions as well as providing wayfinding to patients and/or visitors.

Type of Opportunity: Full time Job Exempt: No Job is based: Presbyterian Hospital Work Shift: Days (United States of America)

Responsibilities:

• Ability to provide 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 at time of service through account review.

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 information, not obtained during pre-registration/financial clearance process, necessary for account completion.
• Review Urgent/Emergent admission accounts for notification.
• 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 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 strong 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 at time of service if not completed during financial clearance process.
• 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 at time of service. .
• Maintain appropriate records, files, and timely and accurate documentation in the system of record.
• Other duties as assigned

Financial Accountabilities:

• Collects identified patient financial obligation amounts including residual balance if applicable. Collect liability from patient 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 Patient Relations
• Complete any information missing from the account to ensure accuracy at time of visit.
• Transparency with patients through communication of patient liabilities..

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.

Qualifications:

• High school diploma or GED required.
• 1 years of work experiences in Patient Access and/or billing, plus strong customer service background.
• Completion and passing of Patient Access Advocate II Advancement test. Can be taken every 6 months once experience guidelines have been met.
• CHAA, CHAM or other industry equivalent certification preferred
• Strong understanding of insurance and financial processing of accounts.
• Basic understanding 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 registration and healthcare practices, financial guidelines, and coordination of benefits.
• Ability to work independently, self-directed and work with individuals with diverse background.
• Effective communication skills.
• Analytical and problem solving skills
• Knowledge in Microsoft Office Products
• Having completed or completion of 2 week Patient Access Academy with a passing score of 85% or higher.
• Pass annual competency exam for all areas of responsibility.
• Attend Staff meetings
• Attend Employee Forums
• Demonstrated strong keyboarding skills, ensuring efficient data entry and documentation.
• Knowledge in Microsoft Office Products.
• Pass EPIC proficiency test required with a 85% score at completion of the Epic Training class.

Candidates must be at least 18 years of age at the time of hire

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits. Wellness 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.

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.

About Presbyterian Healthcare Services

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.

AA/EOE/VET/DISABLED.

PHS is a drug-free and tobacco-free employer with smoke free campuses.

We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services

Here, we’re committed to a different way to make a difference. Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, nurses, employees, board members, and volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than one in three New Mexicans. 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.

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