Patient Access Coordinator I-Pediatrics-Part-time

Highmark Health; Pennsylvania; On-site; USD 32,000 - 45,000; Full time

Job summary

Allegheny Health Network is seeking a Patient Access specialist to support our pediatric expansion. This role will rotate schedules between Monday-Saturday, 7am-8pm, and involves scheduling, preregistration, financial clearance, and authorization and referral validation.

You will communicate clearly with patients and families, estimate financial responsibilities, and work with Payors, physicians, and care teams to ensure accurate bill submission.

Qualifications

• High school diploma or GED; or 1-3 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

Responsibilities

• Performs scheduling and preregistration functions, validates patient data, identifies and verifies medical benefits, applies correct plan codes and COB orders.
• Verifies insurance information via payor contacts, online resources, or electronic systems; communicates authorization/referral requirements to physicians and payors.
• Identifies patient financial responsibilities, estimates costs, collects liabilities, and posts transactions in the ADT system; escalates complex liabilities to Financial Counselors when needed.
• Delivers positive patient experience and maintains strong working relationships with patients, AHN leadership and staff, physician offices, and external agencies.
• Supports productivity goals and explores improvements to processes and workflows for better efficiency.
• Follows organizational policies and completes mandatory trainings; performs other duties as assigned.

Skills

Customer service

Insurance verification

Call center

Data entry

Education

High school diploma

GED

Tools

ADT system

Verification software

Job description

Company :

Allegheny Health Network

Job Description :

This role will support our pediatric expansion. This role will rotate schedules between Monday-Saturday, 7am-8pm.

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.

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