The Patient Access Specialist position receives, coordinates and implements the initial patient experience by providing critical functions essential to ensuring proper clinical treatment, billing and reimbursement, patient satisfaction as well as efficient and accurate handling of the patient registration process.
- High School diploma or equivalency
- Minimum three years' experience in healthcare access and/or customer service
- Emphasis on financial analysis of insurance benefits for up front collections
- Focused knowledge with CPT, HCPCS and ICD-10 codes
- Excellent understanding of insurance and medical terminology
- Solid Microsoft Office skills required with a focus on Excel and Word
- Associates or bachelor's degree in Business or Healthcare related field
- Minimum four + years' experience in healthcare access, customer service
- Minimum one-year experience in a financial environment
- Certified Healthcare Access Associate (CHAA) or Certified Medical Insurance Specialist (CMIS)
Core Job Responsibilities
- Assists with Onboarding of new associates
- Cross training of current associates
- Comprehensive Pre-Registration process for specified departments/modalities due to sensitive nature of patient clinical and/or financial needs and complication of required processes
- Accurately completes a quality registration in the HIS system that maintains the integrity of demographic and financial information required for clinical and billing functions for every patient encounter
- Understands and adheres to state and federal regulations and system policies regarding compliance, integrity and ethical registration practices.
- Reviews and ensures that all medical orders are compliant and meet government and hospital guidelines as well as clinical protocols
- Completes clinical screening for specified modalities to ensure patient safety
- Ability to obtain insurance eligibility and benefit information from payors via phone, RTE, or web in order to provide patient with estimated responsibility for services requested or rendered
- Responsible for all patient and claim edits for accuracy and compliance with all government and commercial carriers to ensure a clean claim submission
- Works as a liaison with Centralized Referral Center or assigned entity to ensure prior-authorizations have been obtained to secure payment and prevent denials
- Complete and/or process patient payments for account posting accuracy
- Maintain an accurate cash drawer and functions related to cash drawer reconciliation and deposit
- Responsible for practicing AIDET and all customer/patient related encounters
- Performs other duties assigned by department supervisor or manager
Additional InformationMedical Group of the Carolinas (MGC) is a Spartanburg Regional Healthcare System's physician group, made up of more than 600 physicians in more than 29 specialties and 38 primary care; serving Upstate South Carolina and western North Carolina. MGC has 90 locations, which include primary care, family medicine, internal medicine, specialties, pediatric OB/GYN practices, women's services locations, and immediate care.
The medical network of practices includes family medicine, internal medicine, obstetrics, gynecology, pediatrics, immediate care, emergency medicine, inpatient medicine, allergy, medical weight loss, cardiology, cardiothoracic and vascular surgery, diabetes and endocrinology, gastroenterology, surgery, gynecologic oncology, infectious disease, maternal fetal medicine, occupational health, oncology, hematology, orthopedic surgery, palliative care, pediatric critical care, physical medicine and rehabilitation, plastic surgery, psychiatry, radiation oncology, rheumatology, vascular access and wound care.
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