Patient Access Coordinator I - Valley Brook - McMurray - FT

Highmark Health; McMurray (PA); On-site; USD 36,000 - 54,000; Full time

Job summary

Allegheny Health Network seeks a Patient Access professional to handle scheduling, preregistration, and financial clearance, ensuring accurate data and timely bill submission.

You will verify insurance, determine authorization/referral needs, and communicate with physicians, case management, and payors. The role emphasizes patient-centric service, adherence to HIPAA, and cross-functional collaboration.

Qualifications

• Minimum high school diploma or GED, or equivalent combination of education and experience.
• One year of related experience, preferably within a medical or financial services setting.
• Experience operating a PC and using software; familiarity with medical terminology and insurance verifications; call/service center experience.

Responsibilities

• Conduct scheduling and preregistration functions, validate demographics, identify and verify medical benefits, accurate plan code and COB order; update data for timely bill submission.
• Verify insurance information through payor contacts or verification system; provide documentation to physician offices, case management, and payors regarding deficiencies.
• Identify patient financial responsibilities, calculate estimates, collect liabilities and post payments in the ADT system; escalate complex cases.
• Delivers positive patient experience and maintains relationships with patients, AHN leadership and staff, physician offices, and external agencies.
• Maintain productivity, propose improvements, and complete mandatory trainings within guidelines.
• Performs other duties as assigned.

Skills

Scheduling

Pre-registration

Financial clearance

Insurance verification

HIPAA compliance

Education

High school diploma or GED

Tools

ADT system

PC skills

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.