Patient Access Coordinator I-Behavioral Health

Highmark Health; Pittsburgh (Allegheny County); On-site; USD 34,000 - 45,000; Full time

Job summary

Highmark Health, serving Allegheny Health Network in Pittsburgh, seeks a Patient Access representative to schedule, preregister, verify benefits, and estimate patient financial responsibilities. You will communicate clearly with patients and families to explain processes and expected costs while ensuring accurate data submission.

In this role, you will coordinate with physicians, payors, and care teams to obtain authorizations, manage referrals, and support financial clearance and collections in

Qualifications

• Requires high school diploma or GED or equivalent; 0–3 months related experience preferred.
• Experience in medical/financial services or customer service is advantageous.

Responsibilities

• Performs scheduling and preregistration with accurate demographic data.
• Verifies insurance information and determines authorization/referral requirements.
• Calculates patient financial responsibilities and conducts post‑payment transactions in ADT system.
• Delivers positive patient experience and maintains relationships with patients, physicians, and external contacts.
• Maintains productivity and adheres to organizational policies and training requirements.
• Performs other duties as assigned.

Skills

Scheduling

Pre-registration

Insurance verification

Financial clearance

Authorization & referrals

Patient communication

Data accuracy

Customer service

Education

High school diploma or GED

Tools

ADT system

Electronic verification system

Payor portal

Job description

Company : Allegheny Health Network Job Description :

GENERAL OVERVIEW

Completes one or more of the following processes (scheduling, pre-registration, financial clearance, authorization and referral validation and pre-serviceability estimations and collections) within Patient Access and creates the first impression of AHN's services to patients and families and other external customers. Articulates information in a manner that patients, guarantors and family members understand so they know what to expect and understand their financial responsibilities. Assumes clinical and financial risk of the organization when collecting and documenting information on behalf of the patient.

ESSENTIAL RESPONSIBILITIES

• Conducts scheduling, and preregistration functions, validates patient demographic data, identifies and verifies medical benefits, accurate plan code and COB order. Obtains limited clinical data based on service required. Corrects and updates all necessary data to assure timely, accurate bill submission. (30%)
• Verifies insurance information through payor contacts via telephone, online resources, or electronic verification system. Identifies payor authorization/referral requirements. Provides appropriate documentation and follow up to physician offices, case management department, and payors regarding authorization/referral deficiencies. (20%)
• Identifies all patient financial responsibilities, calculates estimates, collects liabilities and post payment transactions as appropriate in the ADT system and performs daily reconciliation. Identifies self-pay and complex liability calculations and escalates account to Financial Counselors as appropriate. (20%)
• Delivers positive patient experience. Cooperates with and maintains excellent working relationships with patients, AHN leadership and staff, physician offices and designated external agencies or vendors. Performs any written or verbal communication necessary to exchange information with designated contacts and promote working relationships. (10%)
• Maintains focus on attaining productivity standards, recommending innovative approaches for enhancing performance and productivity when appropriate. (10%)
• Adheres to AHN organizational policies and procedures for relevant location and job scope. Completes and/or attends mandatory training and education sessions within approved organizational guidelines and timeframes. (10%)
• Performs other duties as assigned or required.

QUALIFICATIONS

Minimum High school diploma or GED; or one – three months related experience and/or training; or equivalent combination of education and experience. One previous year of related experience, preferably within a medical setting, financial services setting, and/or a demanding customer service environment Experience operating a PC and using software applications Preferred Medical terminology and obtaining insurance verifications Call/Service Center experience

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement

This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

California Consumer Privacy Act Employees, Contractors, and Applicants Notice Highmark Health is a national, blended health organization that includes one of America’s largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network. Based in Pittsburgh, Pa., Highmark Health’s 35,000 employees serve millions of customers nationwide through the nonprofit organization’s affiliated businesses, which include Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services. Highmark Health’s businesses proudly serve a broad spectrum of health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions.