Patient Access Coordinator I - Primary Care - Monroeville - Full-time

Allegheny Health Network; Monroeville (Allegheny County); On-site; USD 38,000 - 48,000; Full time

Job summary

Allegheny Health Network is seeking a Patient Access Specialist to manage scheduling, pre-registration, and financial clearance, ensuring accurate data and timely bill submission. You will verify insurance, collect patient liabilities, and support physicians and payors with authorization needs to minimize denials.

Ideal candidates have strong data entry skills, excellent customer service, and the ability to communicate clearly with patients and staff while adhering to HIPAA and organizational

Qualifications

• High school diploma or GED or equivalent.
• One year of related experience preferred in healthcare, financial services, or customer service.
• Experience operating a PC and using software applications.

Responsibilities

• Conduct scheduling and pre-registration with data accuracy.
• Validate demographic data and verify medical benefits.
• Obtain and verify insurance information and required authorizations.
• Identify patient financial responsibilities and collect liabilities.
• Deliver positive patient experience and maintain relationships with AHN staff.
• Adhere to HIPAA and company policies and complete required trainings.

Skills

Scheduling

Pre-registration

Insurance verification

Customer service

Education

High school diploma or GED

Tools

PC proficiency

Job description

Company

Allegheny Health Network

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.

Minimum Qualifications

• High school diploma or GED; or one to 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 Qualifications

• Medical terminology and obtaining insurance verifications.
• Call/Service Center experience.

Compliance and Legal Requirements

As part of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. All employees must comply with 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, every employee must comply with the company’s Code of Business Conduct, which includes adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Equal Opportunity Employer

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.