Trinity Health

Patient Access Specialist I

Trinity Health, Chelsea

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Employment Type:

Full time

Shift:

12 Hour Day Shift

Description:

GENERAL SUMMARY:

Under limited supervision; determines need for and obtains authorization for treatment / procedures and assignment of benefits required. Provides information to patients concerning regulatory requirements. Provides estimated costs and patient responsibility, facilitating collection of co-pay, deductible and private pay balances. Responsible for the complete and accurate collection of patient demographic and financial information for the purpose of establishing the patient and service specific record for claims processing and maintenance of an accurate electronic medical record. Registers and checks-in patients and determines preliminary patient and insurance liability. Performs account analysis, problem solving and resolution of patient account issues. Initiates billing and rebilling of accounts as appropriate.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Interviews patients and gathers information to assure accurate and timely claims submission. Interprets information collected to determine and create comprehensive visit-specific billing records. Determines need for and obtains authorization for treatment/procedures and assignment of benefits as required.

Maintains competency by participating in on site and external training opportunities.

Utilize skills gained from training sessions to improve and enhance their work processes and customer interactions.

Provides information to patients concerning hospital policies and regulatory requirements utilizing effective interpersonal and guest-relations skills.

Provides assistance to other Health System or physician offices staff regarding registration, insurance verification and authorization requirements and processes.

Determines appropriate payment required at point of registration (deposits, co-pays, minimum charges and non-covered services.)

Collects payment at time of registration or check-out. Based on planned services provides estimated costs and patient responsibility for both procedural and complex services.

Documents communication with patients related to estimates within the patient accounting record. Verifies procedural and diagnosis codes submitted by service departments and physicians to assure accuracy for claims submission and adjudication of reimbursement.

Verifies insurance eligibility with payors.

Determines benefits and ensures authorization requirement are met.

Interacts with ordering practitioner and patient to coordinate service and insurance requirements.

Contacts patients to discuss eligibility and benefits and requirements specific to clinical services.

Creates appropriate registration record.

Communicates with patients their financial responsibility, benefit and authorization status prior to clinical services.

Facilitate cash collection as appropriate prior to and at the time of service, including copays, deductibles, and private pay responsibility.

Obtains insurance authorization, patient liability acknowledgement, acknowledgement of non-covered services and advance beneficiary notices and consent forms.

Explains the purpose of these forms to patients and responds to question related to their intent.

Completes as required; obtains signatures and approvals; verifies that information is complete and accurate. Is proficient at the use of automated tools and makes appropriate decisions related to the relationship of the action required and the tool used.

Explains accounts to patients and translates registration and billing issues to patient understanding. Identifies opportunities to improve the quality of registration, billing or verification procedures. Responds to patient questions concerning insurance coverage, benefit coverages for their insurance plans.

Demonstrates accountability to follow-up with patients concerning requests for information or action regarding their account.

Knows where to obtain information to assist PFS team members, patients, internal and external customers.

Assists patients or physician office staff by referring to the appropriate sources of information.

Demonstrates team-player abilities and seamless service to patients.

Occasionally assist with training of new employees and cross training of other team members. Maintains good rapport and cooperative relationships.

Approaches conflict in a constructive manner.

REQUIRED EDUCATION, EXPERIENCE

Education:

Requires high school diploma or equivalent.

Experience:

One or two years related experience.

REQUIRED SKILLS AND ABILITIES

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Demonstrated computerized system application experience.
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Critical thinking and problem-solving skills.
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Analytical ability to affective and efficiently resolve registration, insurance and claims processing issues.
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Demonstrated knowledge of revenue cycle processes and terminology.
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Interpersonal skills to effectively communicate with patients, team members, clinical colleagues, medical staff, third party providers, and external agencies and contacts.
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Exceptional customer service skills and positive personality attributes.
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Patience in dealing with ordinary, arduous or emotional patients.
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Use of telephones.
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WORKING CONDITIONS

Normal office environment.

REPORTING RELATIONSHIPS

Supervision provided by PFS Manager.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran