Patient Access Associate
AtlantiCare, Pomona, NJ, United States
Position Summary
The Patient Access Associate I will perform duties after an eight‑week training program under the supervision of the Patient Access Leadership Team and Revenue Cycle Quality & Assurance Training Team. This position is a customer service champion responsible for delivering great customer service at each entry point throughout the health system. This position supports organizational goals by providing high‑level, quality customer service, participating in performance‑improvement efforts, and demonstrating a commitment to teamwork and cooperation while verifying and preparing all patient accounts for inpatient and outpatient billing to maximize payment for hospital and clinic services from all sources.
Principal Duties And Job Responsibilities
Responsible for the patient pre‑registration, registration, general admissions, and financial assistance processing.
Will be knowledgeable of state and federal government funding programs such as Medicare, Medicaid, TRICARE/CHAMPUS, Workers' Compensation; No Fault Auto, and commercial insurance payers.
Will be knowledgeable of billing and reimbursement guidelines and methodologies for state and federal government and non‑government payers; insurance terminology; basic medical terminology, EMTALA, HIPAA privacy, and compliance practices.
Ensures all demographic and insurance information is obtained and correct, scans IDs and insurance cards as needed, sends query for insurance eligibility information provided by the patient and/or representative to validate eligibility, and accurately documents in the registration system. Informs patient of insurance out‑of‑network status as appropriate and accurately completes the Medicare Secondary Payer Questionnaire for all Medicare‑eligible patients.
Verifies insurance information through payer contact via telephone, online resources, or electronic verification system.
Responsible for verifying diagnosis codes and completing medical necessity checks for Medicare. The Patient Access Associate I must have basic knowledge of ICD‑10 to ensure accurate diagnosis entry for reimbursement.
Identifies and obtains payer authorizations, pre‑certifications, and/or referrals; provides appropriate documentation and follows up with physician offices, case management, and payers regarding authorization/referral deficiencies. Communicates to service line partners when rescheduling is necessary due to lack of authorization and/or limited benefits and is approved by clinical personnel.
In working inpatient accounts, is responsible for timely notification to payers of the patient’s admission to the facility.
Identifies all patient financial responsibilities, calculates estimates, collects all payments due (including current estimates, outstanding balances, and self‑pay deposits), and posts payment transactions in the system. Performs daily reconciliation, escalates self‑pay and complex liability calculations to Financial Counselors as appropriate, and provides estimates for consumer shopper comparison.
Appropriately collects and/or sets payment arrangements with patients or their representatives, scheduling payments on deposits due, which may include screening of patients for enrollment in available credit option programs. Documents all collection attempts using approved verbiage promptly and consistently. Proactively seeks assistance to improve collections.
Ensures all patients with questions or concerns regarding their bills are referred to the appropriate resource, including initiation of financial counseling when appropriate.
Documents pertinent activity on the patient account via notes.
Maintains current knowledge of online and system tools available, working from manual reports during system downtime.
Communicates and collaborates with Patient Access team members and other ancillary departments as needed.
Attends all required training and in‑services and passes all competency tests associated with the in‑services.
May be responsible for additional duties as assigned within the Patient Access job scope.
Qualifications
Education and Experience
High school diploma or equivalent required.
0–1 year experience in healthcare registration or a relevant customer service environment required.
Previous experience in a physicians' office or hospital setting is preferred.
The Patient Access Associate I can perform job duties based on department procedure and protocol; may require direct oversight.
License/Certification
Healthcare Financial Management Association (HFMA) CRCR Certified Revenue Cycle Representative certification required within 120 days of hire or transfer.
Knowledge and Skills
Ability to communicate effectively both verbally and in writing; read, understand, and apply policies and guidelines; obtain information from a variety of sources.
Knowledge of general computer and data entry functions.
Excellent communication, customer service, organizational, and analytical skills.
Ability to prioritize and manage multiple tasks simultaneously, anticipate and respond to issues in a dynamic work environment.
Continuously display professionalism, courtesy, and respect to all customers mirroring AtlantiCare's Values/Behaviors.
Must have reliable means of transportation.
Bilingual preferred.
Performance Expectations
Demonstrate competencies as established on the Assessment and Evaluation Tool for this position.
Must pass annual recertification with a score of 95% or better each year; staff will be required to retrain until the appropriate grade or disciplinary action will ensue.
Maintain a high accuracy rate of 98% or higher and established productivity rates for Key Performance Indicators (KPI) such as cash collections wait and TAT times, pre‑registration, and registration productivity.
Opportunity for advancement to Patient Access Associate II if all requirements are satisfied and the employee has been in the role for 15 months.
Work Environment
Potential exposure to hazards and risk of the hospital environment, including infectious disease, hazardous substances, and potential injury.
Requires reaching, stooping, kneeling, and crouching approximately 25% of the workday; may require pushing and pulling computers on wheels up to 100% of the day if assigned to the Emergency Department or Labor and Delivery; high‑volume fast‑paced environment.
Essential functions are listed on the Assessment and Evaluation Tool.
Total Rewards at AtlantiCare
At AtlantiCare, we believe in supporting the whole person. Our market‑competitive Total Rewards package is designed to promote the physical, emotional, social, and financial well‑being of our team members. We offer a comprehensive suite of benefits and resources, including:
Generous Paid Time Off (PTO)
Medical, Prescription Drug, Dental & Vision Insurance
Retirement Plans with employer contributions
Short‑Term & Long‑Term Disability Coverage
Life & Accidental Death & Dismemberment Insurance
Tuition Reimbursement to support your educational goals
Flexible Spending Accounts (FSAs) for healthcare and dependent care
Wellness Programs to help you thrive
Voluntary Benefits, including Pet Insurance and more
Benefits offerings may vary based on position and are subject to eligibility requirements. Join a team that values your well‑being and invests in your future.
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The Patient Access Associate I will perform duties after an eight‑week training program under the supervision of the Patient Access Leadership Team and Revenue Cycle Quality & Assurance Training Team. This position is a customer service champion responsible for delivering great customer service at each entry point throughout the health system. This position supports organizational goals by providing high‑level, quality customer service, participating in performance‑improvement efforts, and demonstrating a commitment to teamwork and cooperation while verifying and preparing all patient accounts for inpatient and outpatient billing to maximize payment for hospital and clinic services from all sources.
Principal Duties And Job Responsibilities
Responsible for the patient pre‑registration, registration, general admissions, and financial assistance processing.
Will be knowledgeable of state and federal government funding programs such as Medicare, Medicaid, TRICARE/CHAMPUS, Workers' Compensation; No Fault Auto, and commercial insurance payers.
Will be knowledgeable of billing and reimbursement guidelines and methodologies for state and federal government and non‑government payers; insurance terminology; basic medical terminology, EMTALA, HIPAA privacy, and compliance practices.
Ensures all demographic and insurance information is obtained and correct, scans IDs and insurance cards as needed, sends query for insurance eligibility information provided by the patient and/or representative to validate eligibility, and accurately documents in the registration system. Informs patient of insurance out‑of‑network status as appropriate and accurately completes the Medicare Secondary Payer Questionnaire for all Medicare‑eligible patients.
Verifies insurance information through payer contact via telephone, online resources, or electronic verification system.
Responsible for verifying diagnosis codes and completing medical necessity checks for Medicare. The Patient Access Associate I must have basic knowledge of ICD‑10 to ensure accurate diagnosis entry for reimbursement.
Identifies and obtains payer authorizations, pre‑certifications, and/or referrals; provides appropriate documentation and follows up with physician offices, case management, and payers regarding authorization/referral deficiencies. Communicates to service line partners when rescheduling is necessary due to lack of authorization and/or limited benefits and is approved by clinical personnel.
In working inpatient accounts, is responsible for timely notification to payers of the patient’s admission to the facility.
Identifies all patient financial responsibilities, calculates estimates, collects all payments due (including current estimates, outstanding balances, and self‑pay deposits), and posts payment transactions in the system. Performs daily reconciliation, escalates self‑pay and complex liability calculations to Financial Counselors as appropriate, and provides estimates for consumer shopper comparison.
Appropriately collects and/or sets payment arrangements with patients or their representatives, scheduling payments on deposits due, which may include screening of patients for enrollment in available credit option programs. Documents all collection attempts using approved verbiage promptly and consistently. Proactively seeks assistance to improve collections.
Ensures all patients with questions or concerns regarding their bills are referred to the appropriate resource, including initiation of financial counseling when appropriate.
Documents pertinent activity on the patient account via notes.
Maintains current knowledge of online and system tools available, working from manual reports during system downtime.
Communicates and collaborates with Patient Access team members and other ancillary departments as needed.
Attends all required training and in‑services and passes all competency tests associated with the in‑services.
May be responsible for additional duties as assigned within the Patient Access job scope.
Qualifications
Education and Experience
High school diploma or equivalent required.
0–1 year experience in healthcare registration or a relevant customer service environment required.
Previous experience in a physicians' office or hospital setting is preferred.
The Patient Access Associate I can perform job duties based on department procedure and protocol; may require direct oversight.
License/Certification
Healthcare Financial Management Association (HFMA) CRCR Certified Revenue Cycle Representative certification required within 120 days of hire or transfer.
Knowledge and Skills
Ability to communicate effectively both verbally and in writing; read, understand, and apply policies and guidelines; obtain information from a variety of sources.
Knowledge of general computer and data entry functions.
Excellent communication, customer service, organizational, and analytical skills.
Ability to prioritize and manage multiple tasks simultaneously, anticipate and respond to issues in a dynamic work environment.
Continuously display professionalism, courtesy, and respect to all customers mirroring AtlantiCare's Values/Behaviors.
Must have reliable means of transportation.
Bilingual preferred.
Performance Expectations
Demonstrate competencies as established on the Assessment and Evaluation Tool for this position.
Must pass annual recertification with a score of 95% or better each year; staff will be required to retrain until the appropriate grade or disciplinary action will ensue.
Maintain a high accuracy rate of 98% or higher and established productivity rates for Key Performance Indicators (KPI) such as cash collections wait and TAT times, pre‑registration, and registration productivity.
Opportunity for advancement to Patient Access Associate II if all requirements are satisfied and the employee has been in the role for 15 months.
Work Environment
Potential exposure to hazards and risk of the hospital environment, including infectious disease, hazardous substances, and potential injury.
Requires reaching, stooping, kneeling, and crouching approximately 25% of the workday; may require pushing and pulling computers on wheels up to 100% of the day if assigned to the Emergency Department or Labor and Delivery; high‑volume fast‑paced environment.
Essential functions are listed on the Assessment and Evaluation Tool.
Total Rewards at AtlantiCare
At AtlantiCare, we believe in supporting the whole person. Our market‑competitive Total Rewards package is designed to promote the physical, emotional, social, and financial well‑being of our team members. We offer a comprehensive suite of benefits and resources, including:
Generous Paid Time Off (PTO)
Medical, Prescription Drug, Dental & Vision Insurance
Retirement Plans with employer contributions
Short‑Term & Long‑Term Disability Coverage
Life & Accidental Death & Dismemberment Insurance
Tuition Reimbursement to support your educational goals
Flexible Spending Accounts (FSAs) for healthcare and dependent care
Wellness Programs to help you thrive
Voluntary Benefits, including Pet Insurance and more
Benefits offerings may vary based on position and are subject to eligibility requirements. Join a team that values your well‑being and invests in your future.
#J-18808-Ljbffr