Patient Access Coordinator II - Bellevue - Full time - Day Shift

West Penn Allegheny Health System; Bellevue (Allegheny County); On-site; USD 22,000 - 33,000; Full time

Job summary

Allegheny Health Network is seeking an Patient Access professional to handle scheduling, preregistration, and financial clearance processes. You will verify benefits, determine authorization needs, and communicate clearly with physicians, patients, and payors.

The role emphasizes accurate data entry, patient confidentiality, and timely information exchange to ensure accurate bill submission and smooth patient flow. A high school diploma and prior experience are preferred.

Qualifications

• Minimum high school diploma or GED.
• Two years of related experience preferred in medical or financial services environments.
• Experience operating a PC and using software applications.

Responsibilities

• Schedules and preregisters patients, and validates demographic data.
• Verifies insurance information and authorization/referral requirements.
• Calculates patient liabilities and posts payments in the system.
• Delivers a positive patient experience and maintains professional relationships with stakeholders.
• Adheres to organizational policies and completes required trainings.

Skills

Customer service

Data entry

Phone etiquette

Attention to detail

Education

High school diploma or GED

Tools

PC software

Job description

Company : Allegheny Health Network Job Description :

GENERAL OVERVIEW: This job 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. Trains and assists other team members as necessary.

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. (20%)
• 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%)
• Communicates team barriers, process flow or productivity issues to team lead. Assists team members with operational support and training. Assists in resolving patient issues requiring additional oversight in a concise and informative manner as required. (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.
• Two previous years 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 Certification with Healthcare Financial Management Association or Certified Revenue Cycle Representative.
• 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.