Patient Access Specialist - PreCertification

St. Tammany Parish Hospital; United States; On-site; USD 42,000 - 54,000; Full time

Job summary

St. Tammany Health System in Covington, LA, is seeking a Patient Access Specialist to handle registration, check-in/out, admission, insurance initiation and verification, and scheduling. Strong customer service, HIPAA sensitivity, and confidentiality are essential.

Responsibilities include verifying coverage, initiating authorizations, posting payments, and aiding physicians, staff and patients; mentoring other staff and ensuring accurate data entry in HIS systems.

Qualifications

• High school diploma or equivalent; some college preferred.
• At least 1 year of customer service in a medical/office setting including scheduling and admitting.
• Ability to communicate clearly with patients, staff, and insurers.
• Knowledge of CPT/ICD-10 coding and insurance terminology preferred.

Responsibilities

• Verify insurance coverage and benefits; initiate authorizations.
• Complete registration in HIS systems and schedule appointments.
• Determine payer liability and check medical necessity.
• Post daily point-of-service payments and resolve patient balances.
• Train and mentor other Patient Access staff.

Skills

Customer service

Communication

Privacy compliance

Education

High school diploma or equivalent

Some college preferred

CHAA certification (helpful)

Tools

HIS systems

Job description

At St. Tammany Health System, delivering world-class healthcare close to home is our goal. That means we are committed to attracting and retaining the very best professionals for every position in our health system. We believe the pristine beauty of St. Tammany Parish adds to our attractive compensation package. The health system is nestled in the heart of Covington on the north shore of Lake Pontchartrain. It is a peaceful, scenic, community-oriented area with an abundance of amenities to suit every taste.

JOB DESCRIPTION AND POSITION REQUIREMENTS

Scheduled Weekly Hours: 40 Hours: Mon - Fri, 8:30 am - 5:00 pm Summary of the Job: The Patient Access Specialist is responsible for completing efficient and organized processes in the areas of registration, check-in/check-out, admission, insurance initiation and verification and benefit research for inpatients/outpatients and scheduling of appointments. Excellent customer service skills are crucial in these roles as well as flexibility in work shifts. The Patient Access Specialist must ensure that accurate information is collected, that they are always sensitive to the confidentiality of this information, and that patients are aware of their rights as determined by HIPAA regulations and company policy, and that they are a consistent proponent of patient throughput and volume growth.

RESPONSIBILITIES

The Patient Access Specialist responsibilities include duties such as verifying insurance coverage, benefits, obtaining and initiating authorizations, completing registration pathways in the HIS systems, receiving, maintaining, clarifying, entering and/or validating physician orders, scheduling appointments, determining third party payer liability for organizational billing, checking medical necessity, handling daily batching and posting of point of service payments and having conversations with patients to resolve previous and current balances. Maintains a positive relationship with healthcare team and is a resource to physicians, staff and patients for information regarding orders, insurance and referrals, as well as any other issues that might impact the relationship/experience of these stakeholders. The Specialist is also responsible for training and mentoring other Patient Access Representatives and Specialists in the more technical aspects of job.

MINIMUM QUALIFICATIONS

High school diploma or equivalent. Some college preferred. At least 1 year of previous customer service experience in an office / medical office environment including scheduling, admitting, and/or financial counseling.

PREFERRED QUALIFICATIONS

Excellent written and verbal communication skills demonstrating the ability to communicate effectively and courteously with physician office staff, patients, and/or insurance carriers. Ability to work in a fast-paced professional environment. Demonstrated competency to successfully perform Patient Access Representative duties, which would typically be obtained through 12 months direct experience. Ability to understand and solve complex problems dealing with governmental entitlement programs, commercial insurance requirements, contractual obligations, and reporting requirements. Ability to apply the use and terminology associated with CPT and ICD-10 coding, as well as basic anatomy/physiology, and out-patient diagnostic testing medical terminology, Medicare guidelines, HMO and PPO contracts and other insurance billing processes. Excellent organizational skills and maintains a professional and neat work environment. Please note – some of these positions are essential personnel during disaster situations (like Hurricane evacuations/threats). These essential positions include ER Patient Access Specialists and some Lead level positions. Please inquire during the hiring process to ensure you are aware of the requirement for your position. Depending on location, process and system knowledge will differ. Examples include order entry at the outpatient locations and scheduling in some satellite locations. While not required, education or certifications in the following areas are helpful in acquiring a position in the area - as well as for advancement opportunities: Certified Healthcare Access Associate (CHAA) through the National Association of Healthcare Access Management (NAHAM) Completion of a medical terminology course. Bilingual - preferably Spanish.

PHYSICAL DEMANDS

Must possess good physical health. Some requirements include but are not limited to standing, sitting or walking for long periods of time. Lifting at least 20 pounds is required. Must be able to work with a moderate level of noise. Physical Effort required: Constant (67%-100%) - handling/feeling, talking, hearing, seeing Frequently (34%-66%) – reaching Occasionally (1%-33%) - lifting, carrying, pushing/pulling, climbing (stairs, ladders, etc.), balancing, stooping, crouching

EMPLOYMENT

Each St. Tammany Health System staff member is expected to conduct himself or herself according to our mission, vision and values. St. Tammany Health System is a full-service acute care facility that delivers today’s life-improving procedures with the latest technology, highest quality and the utmost care to area residents. From wellness and prevention to diagnosis, treatment, rehabilitation and recovery, the St. Tammany Health System delivers the very latest technology, the most accomplished specialists and highly personalized, caring staff to ensure patients and their families receive world-class healthcare close to home. St. Tammany Health System is an independent service district in a clinically integrated partnership with Ochsner Health System. Together, the two organizations focus on aligning their healthcare offerings to best serve patients and families in west St. Tammany Parish and surrounding areas.

EQUAL OPPORTUNITY EMPLOYER

St. Tammany Health System is an Equal Opportunity Employer. St. Tammany Health System is committed to equal employment opportunity for all employees and applicants without regard to race, color, religion, sex, age, national origin or ancestry, citizenship, sexual orientation, gender identity, veteran status, disability status, genetic information or any other protected characteristic under applicable law.