Patient Access & Financial Counselor

capefearvalley; United States; On-site; USD 38,000 - 52,000; Full time

Job summary

Cape Fear Valley Medical Center in Fayetteville, NC, is seeking a Patient Access Specialist to manage accounts, verify insurance, and collect patient responsibilities. You will interview patients, validate demographics and insurance, and ensure authorizations are in place for procedures.

The role requires strong communication, knowledge of insurance processes, and accuracy while navigating patient accounts and HIPAA guidelines.

Qualifications

• High school graduate or equivalent required.
• Associates Degree in Business or Health Care Administration and/or Computer Technology preferred
• Patient Access Specialist certification (CPAS) required within 1 year of employment
• 1 year insurance/clerical experience within a hospital or medical office setting

Responsibilities

• Contacts and interviews patients, responsible parties and insurance companies regarding hospital or ambulatory service to secure insurance benefits.
• Performs insurance eligibility/benefit verification, utilizing a variety of mechanisms (EDI transactions, web access and by calling payers) and documenting information within the appropriate registration system, supporting with reference number.
• Determines the need for appropriate service authorizations (pre-certifications, 3rd party authorizations, referrals) and contacts the payer, physician and/or case management/utilization review personnel, as necessary. Ensure authorization matches test(s) ordered
• Pre-registers the patient for upcoming visit(s) including validating/obtaining and entering demographic, financial, and insurance information.
• Validates medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance.
• Contacts physicians/office staff for clarification, if cases require clarification of diagnosis and/or test(s)/procedure(s).
• Informs patient/guarantor of their liabilities and collects appropriate patient co-payments, co-insurances, deductibles, deposits and outstanding balances at the point of pre-registration.
• Calculates patient liabilities and provides financial education, referring the patient to resource counseling, as required. Documents payments/actions in the patient accounting system and provides the patient with a payment receipt. Assists patient with payment arrangements as needed for remaining balance.
• Properly screens appropriate patients for market insurance.
• Obtains signed physician orders for scheduled tests and procedures from physicians/offices for testing and procedures, and scans into electronic record.
• Completes appropriate follow-up on insurance denials and initiates appeal, retro-authorization, etc. as needed.
• Assists insurance companies, physician, and physician practices, and or hospital departments with patient information in accordance with HIPAA guidelines.
• Meets or exceeds accuracy standard goal determined by Patient Access Leadership; Ensures integrity of patient accounts by working error reports daily, entering accurate data, and documenting all attempts made to collect and or obtain missing documentation.
• Other duties as assigned

Skills

English proficiency

Insurance knowledge

Medical terminology

MS Office

Customer service

Problem solving

Stress management

Shift flexibility

Education

High school diploma

Associates degree in Business/ Health Care Admin

CPAS certification

Job description

Cape Fear Valley Medical Center in Fayetteville, NC, is seeking a Patient Access Specialist to manage accounts, verify insurance, and collect patient responsibilities. You will interview patients, validate demographics and insurance, and ensure authorizations are in place for procedures.

The role requires strong communication, knowledge of insurance processes, and accuracy while navigating patient accounts and HIPAA guidelines.