Patient Access Coordinator II/Registration - AHN Fed North - Full time - Rotating Shifts

Highmark Health / AHN; Pittsburgh (Allegheny County); On-site; USD 38,000 - 52,000; Full time

Job summary

Allegheny Health Network is seeking a Patient Access representative to handle scheduling, preregistration, and financial clearance. You will validate benefits, verify insurance, and communicate with physicians, payors, and patients to set clear expectations and responsibilities.

The role emphasizes accuracy, patient experience, and collaboration with AHN teams. The position requires a high school diploma or GED with related experience, proficiency with PC software, and a customer-service mindset

Qualifications

• High school diploma or GED; or 1–3 months related experience or training, or equivalent combination of education and experience.
• Two years of related experience, preferably in a medical setting or financial services/customer service.
• Experience operating a PC and using software applications.

Responsibilities

• Performs scheduling and preregistration functions and verifies patient demographic data.
• Validates medical benefits, plan code, COB order, and collects limited clinical data as required.
• Verifies insurance information via payor contacts or verification system and coordinates with physicians and payors on deficiencies.
• Identifies patient financial responsibilities, estimates costs, and posts payments; reconciles daily.
• Delivers positive patient experience and maintains relationships with patients, AHN leadership and staff.
• Maintains productivity by suggesting improved processes and adheres to policies and training.
• Communicates barriers and productivity issues to team lead; assists in resolving patient issues as needed.

Skills

Scheduling

Pre-registration

Financial clearance

Authorization validation

Referral validation

Patient communication

Team collaboration

Education

High school diploma or GED

Related experience in medical/financial services

Tools

Electronic Verification System

ADT system

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.

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