Patient Access Account Specialist II
Presbyterian Healthcare Services, Albuquerque, NM, United States
Location Address:
9521 San Mateo NEAlbuquerque, NM 87113-2237
Compensation Pay Range:
Minimum Offer $15.87 Maximum Offer $23.04
Position:
Patient Access Account Specialist II (Full time, Exempt: No, Job Based: Reverend Hugh Cooper Administrative Center, Work Shift: Monday-Friday)
Summary:
Under the direction of the Patient Access Supervisor, the Patient Access Account Specialist II provides all necessary functions to financially clear patient accounts for government and commercial accounts prior to the date of service. Performs all financial clearance functions, including insurance verification, authorization, collection and documentation of patient demographics, benefit analysis, financial counseling, and pre‑service collections. The Patient Access Account Specialist II will ensure follow up on authorizations for scheduled and Urgent/Emergent procedures and admissions until date of service or discharge. The role requires proficient knowledge of Medicare (CMS) guidelines and compliance regulatory guidelines such as HIPAA, EMTALA, and CMS guidelines of MSPQ. The PAAS monitors work queues for financial clearance and missing authorizations, ensuring a payment source is identified and secured for a clean claim. Acts as subject matter expert for all employees within Patient Access and for testing new or existing software. Provides the highest level of customer service to patients, ancillary departments and payers when financially clearing accounts. Works with ancillary departments to ensure scheduled procedures meet payer requirements. Provides coverage to other areas and hospitals as needed.
Responsibilities
Customer Service and Caring Practices:
Achieve exceptional patient experience for patients and patient families by using CARES, AIDET and EPE tools.
Address and attempt to appropriately resolve complaints in the moment using key words and de‑escalation processes.
Manage conflict and request supervisor help when needed.
Implement PROMISE and CARES behaviors in every encounter.
Educate patients regarding insurance benefits and liabilities.
Ensure accounts are financially cleared prior to date of service to alleviate patient concerns over hospital financial matters.
Provide patients with financial options to ensure a payer source for visits.
Encounter Components
Perform the patient registration process and collect accurate demographic and clinical information necessary for final clearance of scheduled and urgent/emergent patient accounts.
Review urgent/emergent admission accounts for notification, financial clearance and authorization pre‑discharge.
Obtain missing insurance information including policy number, group number, date of birth, and insurance phone number if not already identified in account.
Verify insurance for eligibility and benefits using online electronic verification system or by contacting payer directly.
Process work queues related to Patient Access pre‑visit or urgent/emergent admissions, per department guidelines.
Review accounts in work queues to ensure insurance information contains accurate policy IDs, group names and numbers, subscriber information, authorization numbers, and correct payer and coordination of benefits prior to date of service.
Accurately document actions taken in the system of record to drive effective follow‑up and ensure an audit trail.
Maintain knowledge of authorization requirements and payer guidelines. Maintain proficiency in Medicare (CMS) guidelines as they relate to admissions and outpatient services. Ensure compliance with admissions forms, benefit entitlement verification, and billing requirements.
Ensure accurate completion of MSPQ prior to date of service.
Daily focus on attaining productivity standards; recommend new approaches for enhancing performance and productivity when appropriate.
Monitor and track the Data Quality program to ensure errors are corrected prior to final bill and correct accounts as necessary.
Maintain appropriate records, files and timely and accurate documentation in the system of record.
Work with ancillary departments to ensure coding, diagnosis and facility authorization are aligned.
Work with payers to ensure authorization is in place; initiate the auth when appropriate.
Coordinate efforts with Financial Advocates to secure payer source for current and future visits.
Monitor work queues to identify late add‑on accounts and complete financial clearance procedures prior to services to avoid unauthorized procedures.
Work with physician offices to resolve discrepancies in authorizations and scheduled procedures.
Financial Accountabilities
Collect identified patient financial obligation amounts including residual balance if applicable.
Collect liability from patient prior to visit or make arrangements for payment at time of service.
Educate patients on financial assistance, charity or other programs that may be available.
Refer as appropriate to onsite Financial Advocate or to the Financial Advocacy Center.
Ensure a payer source has been identified prior to services being rendered.
Ensure authorization for correct procedure (CPT), facility, and date of service is obtained.
Patient Relations
Contact patients pre‑visit to complete any missing information from the account to ensure accuracy prior to visit.
Provide transparency with patients through communication of patient liabilities and authorization issues in a timely manner.
Educate patients and answer questions on benefits, liabilities and financial options.
Provide patient way‑finding for appointment at time of pre‑registration.
Perform AIDET when speaking to patient to alleviate anxiety and confusion.
Quality Improvement
Cooperate fully in all risk management activities and investigations.
Report promptly any suspected or potential violations to laws, regulations, procedures, policies and practices, and cooperate in related investigation.
Conduct all transactions in compliance with all company policies, procedures, standards and practices.
Demonstrate knowledge of all applicable compliance and legal requirements of the job based on the scope of practice of the position.
C.A.R.E.S Behaviors
Demonstrates CARES behaviors of Collaborate, be Accountable, Respect, Engage and Serve to all whom you encounter.
Other duties as assigned.
Qualifications
High school diploma, continued education preferred.
Previous completion and passing of Patient Access Advocate II and III Advancement test.
Completion and passing of In‑house Patient Access Account Specialist Certification test.
A minimum of 3 years of work experience in healthcare setting with 2 years of Patient Access and/or billing plus strong customer service background.
Robust knowledge and understanding of insurance and financial processing of accounts.
Extended knowledge of medical terminology and billing codes (DRG, ICD‑10, CPT, HCPCS).
Proficient in EPIC ADT system.
Pass annual competency exam for all areas of responsibility.
Specialty certifications: CHAA, CHAM or other industry equivalent certification preferred.
Requires general knowledge of the customer encounter process which may include scheduling, registration, contract requirements, financial guidelines, and coordination of benefits.
Knowledge in Microsoft Office Products.
Demonstrated strong keyboarding skills, ensuring efficient data entry and documentation.
Pass EPIC proficiency test required with an 85% score at completion of the Epic Training class.
All benefits‑eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short‑term and long‑term disability, group term life insurance and other optional voluntary benefits.
AA/EOE/VET/DISABLED. PHS is a drug‑free and tobacco‑free employer with smoke free campuses.
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9521 San Mateo NEAlbuquerque, NM 87113-2237
Compensation Pay Range:
Minimum Offer $15.87 Maximum Offer $23.04
Position:
Patient Access Account Specialist II (Full time, Exempt: No, Job Based: Reverend Hugh Cooper Administrative Center, Work Shift: Monday-Friday)
Summary:
Under the direction of the Patient Access Supervisor, the Patient Access Account Specialist II provides all necessary functions to financially clear patient accounts for government and commercial accounts prior to the date of service. Performs all financial clearance functions, including insurance verification, authorization, collection and documentation of patient demographics, benefit analysis, financial counseling, and pre‑service collections. The Patient Access Account Specialist II will ensure follow up on authorizations for scheduled and Urgent/Emergent procedures and admissions until date of service or discharge. The role requires proficient knowledge of Medicare (CMS) guidelines and compliance regulatory guidelines such as HIPAA, EMTALA, and CMS guidelines of MSPQ. The PAAS monitors work queues for financial clearance and missing authorizations, ensuring a payment source is identified and secured for a clean claim. Acts as subject matter expert for all employees within Patient Access and for testing new or existing software. Provides the highest level of customer service to patients, ancillary departments and payers when financially clearing accounts. Works with ancillary departments to ensure scheduled procedures meet payer requirements. Provides coverage to other areas and hospitals as needed.
Responsibilities
Customer Service and Caring Practices:
Achieve exceptional patient experience for patients and patient families by using CARES, AIDET and EPE tools.
Address and attempt to appropriately resolve complaints in the moment using key words and de‑escalation processes.
Manage conflict and request supervisor help when needed.
Implement PROMISE and CARES behaviors in every encounter.
Educate patients regarding insurance benefits and liabilities.
Ensure accounts are financially cleared prior to date of service to alleviate patient concerns over hospital financial matters.
Provide patients with financial options to ensure a payer source for visits.
Encounter Components
Perform the patient registration process and collect accurate demographic and clinical information necessary for final clearance of scheduled and urgent/emergent patient accounts.
Review urgent/emergent admission accounts for notification, financial clearance and authorization pre‑discharge.
Obtain missing insurance information including policy number, group number, date of birth, and insurance phone number if not already identified in account.
Verify insurance for eligibility and benefits using online electronic verification system or by contacting payer directly.
Process work queues related to Patient Access pre‑visit or urgent/emergent admissions, per department guidelines.
Review accounts in work queues to ensure insurance information contains accurate policy IDs, group names and numbers, subscriber information, authorization numbers, and correct payer and coordination of benefits prior to date of service.
Accurately document actions taken in the system of record to drive effective follow‑up and ensure an audit trail.
Maintain knowledge of authorization requirements and payer guidelines. Maintain proficiency in Medicare (CMS) guidelines as they relate to admissions and outpatient services. Ensure compliance with admissions forms, benefit entitlement verification, and billing requirements.
Ensure accurate completion of MSPQ prior to date of service.
Daily focus on attaining productivity standards; recommend new approaches for enhancing performance and productivity when appropriate.
Monitor and track the Data Quality program to ensure errors are corrected prior to final bill and correct accounts as necessary.
Maintain appropriate records, files and timely and accurate documentation in the system of record.
Work with ancillary departments to ensure coding, diagnosis and facility authorization are aligned.
Work with payers to ensure authorization is in place; initiate the auth when appropriate.
Coordinate efforts with Financial Advocates to secure payer source for current and future visits.
Monitor work queues to identify late add‑on accounts and complete financial clearance procedures prior to services to avoid unauthorized procedures.
Work with physician offices to resolve discrepancies in authorizations and scheduled procedures.
Financial Accountabilities
Collect identified patient financial obligation amounts including residual balance if applicable.
Collect liability from patient prior to visit or make arrangements for payment at time of service.
Educate patients on financial assistance, charity or other programs that may be available.
Refer as appropriate to onsite Financial Advocate or to the Financial Advocacy Center.
Ensure a payer source has been identified prior to services being rendered.
Ensure authorization for correct procedure (CPT), facility, and date of service is obtained.
Patient Relations
Contact patients pre‑visit to complete any missing information from the account to ensure accuracy prior to visit.
Provide transparency with patients through communication of patient liabilities and authorization issues in a timely manner.
Educate patients and answer questions on benefits, liabilities and financial options.
Provide patient way‑finding for appointment at time of pre‑registration.
Perform AIDET when speaking to patient to alleviate anxiety and confusion.
Quality Improvement
Cooperate fully in all risk management activities and investigations.
Report promptly any suspected or potential violations to laws, regulations, procedures, policies and practices, and cooperate in related investigation.
Conduct all transactions in compliance with all company policies, procedures, standards and practices.
Demonstrate knowledge of all applicable compliance and legal requirements of the job based on the scope of practice of the position.
C.A.R.E.S Behaviors
Demonstrates CARES behaviors of Collaborate, be Accountable, Respect, Engage and Serve to all whom you encounter.
Other duties as assigned.
Qualifications
High school diploma, continued education preferred.
Previous completion and passing of Patient Access Advocate II and III Advancement test.
Completion and passing of In‑house Patient Access Account Specialist Certification test.
A minimum of 3 years of work experience in healthcare setting with 2 years of Patient Access and/or billing plus strong customer service background.
Robust knowledge and understanding of insurance and financial processing of accounts.
Extended knowledge of medical terminology and billing codes (DRG, ICD‑10, CPT, HCPCS).
Proficient in EPIC ADT system.
Pass annual competency exam for all areas of responsibility.
Specialty certifications: CHAA, CHAM or other industry equivalent certification preferred.
Requires general knowledge of the customer encounter process which may include scheduling, registration, contract requirements, financial guidelines, and coordination of benefits.
Knowledge in Microsoft Office Products.
Demonstrated strong keyboarding skills, ensuring efficient data entry and documentation.
Pass EPIC proficiency test required with an 85% score at completion of the Epic Training class.
All benefits‑eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short‑term and long‑term disability, group term life insurance and other optional voluntary benefits.
AA/EOE/VET/DISABLED. PHS is a drug‑free and tobacco‑free employer with smoke free campuses.
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