Patient Access Coordinator I - PMA Primary Care - Forest Hills - Full Time

Allegheny Health Network; Pittsburgh (Allegheny County); On-site; USD 36,000 - 60,000; Full time

Job summary

A healthcare provider in Pittsburgh is seeking an Associate for Patient Access Services. In this role, you will conduct scheduling, pre-registration, and financial processes while ensuring a positive experience for patients. The position requires a high school diploma and relevant experience in a medical or customer service setting. Ideal candidates will be detail-oriented and proficient in using PCs and software applications. This is a great opportunity to contribute to a dynamic team and support patient care.

Qualifications

• High school diploma or GED; one–three months related experience or training.
• One previous year of related experience in a medical setting.
• Experience operating a PC and using software applications.

Responsibilities

• Conducts scheduling and pre‑registration functions.
• Verifies insurance information through payor contacts.
• Identifies all patient financial responsibilities and collects liabilities.
• Delivers positive patient experience.
• Maintains focus on productivity standards and suggests improvements when appropriate.
• Adheres to AHN policies and completes mandatory training.
• Performs other duties as assigned.

Skills

Scheduling

Financial clearance

Customer service

Medical terminology

Education

High school diploma or GED

One year of related experience

Tools

PC and software applications

Job description

Company

Allegheny Health Network

Job Description

Across Patient Access, the Associate, Patient Access Services (P#) is responsible for performing scheduling, pre‑registration, financial clearance, authorization/ referral validation, and pre‑serviceability estimations and collections. This role creates the first impression of AHN's services to patients, families and external customers and ensures clear communication regarding services and financial responsibilities. Responsibilities include managing clinical and financial risks on behalf of the patient through accurate documentation and collections.

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 pre‑registration 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 posts 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.

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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