Patient Access Specialist / Eligibility Coordinator Part Time

The Patient Access Specialist performs a range of administrative and patient record maintenance. This includes utilizing the electronic health record (EHR), coordinating prior authorization processes, gathering essential patient information, answering phone calls, and executing other related duties as required. A solid understanding of Internal Medicine, Specialty Practices, Urgent Care, and Pediatric services is necessary for this role.

Essential Position Duties

• Utilizes various online eligibility portals and interacts with payors or patients to ensure that accurate billing information is gathered.
• Exhibits a strong grasp of the coordination of benefits to improve service delivery.
• Efficiently handles inbound calls and proactively initiates outbound calls to both patients and payers.
• Contact patients to collect and update any missing information.
• Communicates coverage limitations to patients before their appointments to set proper expectations.
• Efficiently manages the prior authorization process for both commercial and government insurance plans.
• Reach out to patients via letters or calls regarding terminated coverage, missing demographics, and any necessary documentation updates to maintain accurate records.
• Diligently reviews documentation and updates the patient’s electronic health record with accurate information.
• Regularly collaborates with internal staff, the referral department, PSR staff, the billing department, and providers to ensure smooth operations.
• Engage in face-to-face interactions with patients to assist in updating documentation, gathering missing information, and establishing payment plans for high-balance accounts, thereby improving the patient experience.
• Responsibly collect cost shares (coinsurance, copays & deductibles) to uphold financial transparency and accountability.
• Embrace miscellaneous duties as needed to enhance the overall efficiency and effectiveness of the team.
• Maintains an exemplary attendance record, showcasing commitment, and reliability.

Compliance Responsibilities

• Complies with applicable legal requirements, standards, policies, and procedures, including but not limited to those within the Compliance Process, Code of Conduct, and HIPAA.
• Participates in required orientation and training programs.
• Reports concerns and suspected incidences of non-compliance with the COHC Compliance Reporting Process.
• Cooperates with monitoring, audit functions, and investigations.
• Participates, as requested, in process improvement responsibilities.
• Tracks productivity to enhance efficiencies.

POSITION QUALIFICATIONS

Core Competencies/Skill Sets

• Excellent oral and written communication skills with a strong focus on customer service.
• Capable of analyzing data and efficiently managing multiple tasks independently.
• Builds professional, service-oriented relationships with patients, physicians, and colleagues as a dedicated team player.
• Committed to understanding and following policies and procedures.
• Utilizes critical thinking and attention to detail.
• Maintains a positive demeanor to ensure clear communication with patients and staff.
• Handles confidential information with a priority on privacy.
• Participates in performance improvement initiatives using proactive problem-solving skills.
• Team-oriented; open to feedback and supportive of colleagues.
• Proficient in computer navigation and bilingual (Spanish preferred).
• Upholds the values of Respect, Integrity, Stewardship, and Excellence.

Professional Experience/Educational Requirements

• A high school diploma or GED is essential for this position.
• An associate’s degree is preferred, along with two years of experience in an outpatient healthcare setting, clinical service access, a physician's office, or in billing and collections.
• Candidates should possess demonstrated competencies in performing insurance verification duties effectively.
• Experience in patient registration or Patient Access roles within a healthcare setting is valuable.
• A solid understanding of current trends in insurance billing, prior authorizations, and other third-party reimbursement matters is essential.
• Knowledge of medical terminology will enhance your effectiveness in this role.