Patient Access Specialist

Job Summary

Reporting to the Revenue Cycle Manager and/or their designee, the Patient Access Specialist (PAS) is responsible for confirming patient demographic and insurance information to ensure accurate billing for services provided by Total Health Care (THC). To accomplish this, the PAS must enter all necessary information into Total Health Care’s (THC) Electronic Medical Record (EMR) systems for all departments (i.e., dental, medical, mental health or substance abuse).

The PAS identifies patients in need of financial assistance and assists them per THC policies and procedures. Bilingual in Spanish is preferred.

Contacts and interactions vary and may involve multiple constituencies such as direct interaction with THC’s executive management, community organizers, the general public, THC’s patients, physicians, colleagues, assigned staff, vendors, medical insurance companies (payers)/managed care organizations (MCOs) contractors and consultants for the purpose of providing and exchanging information.

• Completes insurance verification (EVS) on all patients scheduled to be seen at any THC site or department (Pediatrics, Adult Medicine, OB/GYN, Dental, infectious disease, IBH, CESH/Substance Abuse).
• Confirms and enters patient’s current insurance status in the Practice Management System (PMS) at the time of check‑in.
• Communicates co‑pay or payment requirements at time of service.
• Collects payments, co‑payments as well as deductibles at point of service and posts receipts accordingly.
• Completes daily self‑pay log for self‑pay patients and obtains appropriate sign‑off.
• Reconciles receipts and prepares point‑of‑service collections for bank deposit.
• Adheres to company procedures for keeping cash secure.
• Confirms that THC is listed as the facility providing care for the patient and ensures that the specific THC Primary Care Provider is entered in the PMS.
• Confirms authorizations are secured for CESH and Substance Abuse departments for current and upcoming visits.
• Obtains secondary QMB cards for qualified patients.
• Completes Medicare Secondary Payer questionnaire for appropriate coordination of benefits.
• Assists with meeting department goals and department KPIs measures while maintaining integrity.
• Follows up with patient to clarify benefits and correct coordination of benefit issues.
• Provides financial counseling and information about the Maryland Health Connection, including eligibility requirements for applicable federal premium subsidies and cost‑sharing assistance.
• Facilitates enrollment into Medicaid, MCHP, or a Qualified Health Plan.
• Provides referrals to appropriate agencies including the Attorney General’s Health Education and Advocacy Unit (HEAU) and the Maryland Insurance Administration (MIA) for applicants and enrollees with grievances, complaints, questions or the need for other social services.
• Scans front and back of patients’ insurance/identification cards so they can be uploaded to the EMR.
• Completes the primary care provider change form if provider information is not valid, submits it via secure fax and obtains fax confirmation receipt on the day of the visit.
• Assists patients with completion of the Intake/Consent forms and OMS.
• Obtains all necessary signatures and documentation required by the patient’s insurance plan.
• Determines the appropriate financial class and/or account type and correctly assigns primary and secondary insurance billing status when two insurance plans require coordination of benefits.
• Determines eligibility of patients for 30‑day/6‑month sliding fee scale.
• Monitors 6‑month sliding‑fee patients for appropriateness and to determine insurance eligibility status.
• Tracks Department of Social Services vouchers and other third‑party/community payer documentation as well as medical forms and submits them to the Revenue Cycle Manager for billing.
• Other duties as assigned.

High School diploma or equivalent (post‑High School education preferred) and/or any combination of education, training and experience providing understanding of the field and the ability to perform the essential functions of the job. Two years of…