Patient Access Representative

Pioneers Medical Center; Colorado; On-site; USD 27,552 - 31,684; Full time

Job summary

Pioneers Medical Center is seeking a healthcare Revenue Cycle Professional to handle pre-authorizations for imaging, verify insurance details, and advise patients of financial responsibilities. You will collaborate with clinical teams, submit requests via multiple channels, and troubleshoot the authorization system.

Responsibilities include processing requests accurately, handling denials, maintaining confidentiality, and cross-training in registration and discharge processes.

Qualifications

• High school diploma or equivalent required.
• Revenue Cycle courses and continuing education as provided.
• Annual Medicare Fraud and Abuse Education.
• Medicare Secondary Payer documentation.
• Certification as a Revenue Cycle Specialist through AAHAM or as CRCR through HFMA is desired within two years.
• Current BLS required within six months of transfer or hire.
• Knowledge of medical billing practices, including ICD-10, CPT, and HCPCS codes desirable.

Responsibilities

• Obtains pre-authorizations for imaging.
• Reviews information regarding insurance eligibility, deductibles, coinsurance, and/or copays for patients.
• Informs patients of their financial responsibility either via phone or mail.
• Works closely with clinical team to obtain various clinical documents to complete the pre-authorization process.
• Submits requests via insurance portal, fax, or phone.
• Communicates denials to appropriate provider or department.
• Completes requests accurately and timely to ensure quality patient care.
• Understands the Athena/Meditech Authorization Management tool and is able to troubleshoot issues.
• Will cross-train extensively in the areas of hospital and clinic registration and discharge.
• May be required to obtain pre-certification information on hospital and swing bed admits.
• May be required to review and complete Emergency Department registrations.
• Documents appropriate information on accounts on which action has taken place.
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Conducts self in accordance with PMC’s employee manual.
• Makes suggestions and helps with continuous quality improvement in all department processes.
• Maintains up-to-date guidelines to ensure responsibilities of the essential job functions are adequately outlined for training purposes. Manuals are to be easily identified and readily available.
• Participates in educational activities, staff meetings, and in-services as required
• Other duties as assigned.

Skills

Pre-Authorization

Insurance verification

Billing knowledge

HIPAA compliance

Education

High school diploma

BLS certification

Revenue Cycle Certification (AAHAM/HFMA)

Job description

FLSA Classification: Full-Time, Non Exempt, Hourly $19.51 -$23.51

Essential Functions:

• Obtains pre-authorizations for imaging.
• Reviews information regarding insurance eligibility, deductibles, coinsurance, and/or copays for patients.
• Informs patients of their financial responsibility either via phone or mail.
• Works closely with clinical team to obtain various clinical documents to complete the pre-authorization process.
• Submits requests via insurance portal, fax, or phone.
• Communicates denials to appropriate provider or department.
• Completes requests accurately and timely to ensure quality patient care.
• Understands the Athena/Meditech Authorization Management tool and is able to troubleshoot issues.
• Will cross-train extensively in the areas of hospital and clinic registration and discharge.
• May be required to obtain pre-certification information on hospital and swing bed admits.
• May be required to review and complete Emergency Department registrations.
• Documents appropriate information on accounts on which action has taken place.
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Conducts self in accordance with PMC’s employee manual.
• Makes suggestions and helps with continuous quality improvement in all department processes.
• Maintains up-to-date guidelines to ensure responsibilities of the essential job functions are adequately outlined for training purposes. Manuals are to be easily identified and readily available.
• Participates in educational activities, staff meetings, and in-services as required
• Other duties as assigned.

Education and Experience:

• High school diploma or equivalent required.
• Revenue Cycle courses and continuing education as provided.
• Annual Medicare Fraud and Abuse Education.
• Medicate Secondary Payer documentation.
• Certification as a Revenue Cycle Specialist through the American Association of Healthcare Administration Management (AAHAM) or certification as a Certified Revenue Cycle Representative (CRCR) through Healthcare Financial Management Association (HFMA) is desired within two (2) years of employment.
• Current BLS required within six (6) months of transfer or hire.
• Knowledge of medical billing practices, including ICD-1-, CPT, and HCPCS codes desired.

Skills and Expectations:

• Kind and professional demeanor.
• Professional and well-groomed appearance at all times.
• Communicate positively and effectively, both written and verbally, with patients, family, and staff.
• Demonstrate effective organizational skills in an evolving environment.
• Work with honesty, compassion and integrity at all times.
• Understand and adhere to the scope of service for the department and this position.
• Understand and adhere to all of PMC’s policies and procedures.
• Understand and adhere to PMC’s Code of Conduct.
• Adhere to the strictest confidentiality and HIPAA regulations.
• Demonstrate a commitment to building and sustaining a diverse, inclusive, and equitable working environment.
• Ability to remain calm and efficient in emergency situations.
• Demonstrate strong problem-solving skills.
• Demonstrate strong emotional intelligence.

Physical Requirements:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing this job, the employee:

• Must be able to remain in a stationary position 50% of the time.
• Must be able to move and traverse about the facility 50% of the time.
• Frequently transport objects weighing up to 50lbs
• Occasionally position objects weighing up to 100lbs.
• Must be able to communicate and exchange information in a way others will understand.
• Must be able to recognize details such as color and depth within a few feet of the observer.
• Frequently operates computers, machinery, and other healthcare equipment.
• Constantly positions self to complete essential functions.
• May be required to wear N95s or PAPRS throughout the shift.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.