Under the general supervision of department leadership, the Patient Access Coordinator is responsible for referral processing and scheduling patients while ensuring insurance eligibility, benefit verification, pre-registration, and authorization are all completed on time to prevent denials or a delay in patient care. Additionally, the Patient Access Coordinator must determine, communicate, and collect patient liability before service and attempt to collect prior balances. The Specialist will also screen patients who are self-pay or underinsured for financial assistance or other applicable programs as needed.
• Coordinates and processes referral requests, guiding the patient and the referring provider’s office through the intake and scheduling process. This ensures that their needs and expectations are met in a timely manner while providing exceptional customer service.
• Receives referrals via multiple delivery methods, including email, fax, telephone, and EMR interface.
• Schedules patient appointments, including diagnostic tests, procedures, surgeries, physician consultations, post-op/follow-ups, and other ancillary tests.
• Responsible for pre-registering patient appointments by calling insurance companies or using payer portals to obtain and document eligibility and benefits, coverage assignments, and patient financial responsibility.
• Calls patients before appointments and educates them on out-of-pocket expectations.
• Provides procedure estimates and attempts to collect prepayments and outstanding past-due balances.
• Screens patients for the ARH Financial Assistance Program or determines eligibility for referral to other funding resources.
• Performs all tasks to support and obtain pre-authorization from insurance companies, including: • Submitting pre-certification requests and clinical documentation via online portals, phone, and fax with correct CPT and ICD coding. • Researching payer medical policy requirements and treatment authorization guidelines. • Following up on outstanding authorization requests and medical documentation requests promptly. • Communicating with medical/clinical staff and patients regarding authorization status and outcomes. • Communicating with ordering providers regarding denied or disputed determinations.
• Contacts patients and physician offices for additional information and follow-up.
• Responsible for clearing assigned task lists and workloads within EMR systems daily while maintaining quality and productivity standards to ensure the highest level of service and optimal patient care.
• Adheres to all department and organization policies and procedures and state and federal laws and requirements.
• Performs other duties as assigned.
Education
• High school diploma or GED required.
• Several years of experience in patient access, revenue cycle management, or related healthcare administration roles preferred.
• Experience in scheduling, authorizations, and financial counseling preferred.
• Strong understanding of healthcare regulations and compliance requirements.
• Excellent communication, interpersonal, and customer service skills.
• Experience working as a Medical Assistant in a physician practice performing both clinical and administrative duties preferred.
• Certified Medical Assistant preferred, but not required.
• Understanding of best practices for patient access.
• Understanding of insurance eligibility processes.
• Knowledge of customer service principles.
• Knowledge of insurance authorizations and pre-certification requirements.
• Understanding of patient scheduling processes.
• Knowledge of financial counseling practices.
• Ability to communicate effectively with patients, providers, insurance carriers, and staff.
• Ability to manage multiple priorities while maintaining quality and productivity standards.
• Ability to work effectively in a fast-paced healthcare environment.
• Strong organizational and problem-solving skills.
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