Patient Access Coordinator - SVH Urgent Care

GENERAL OVERVIEW

Company:
Allegheny Health Network

Completes one or more of the following processes—scheduling, pre‑registration, financial clearance, authorization and referral validation, and pre‑serviceability estimations and collections—within Patient Access and creates the first impression of AHN's services to patients and families. Articulates information so patients, guarantors, and family members understand what to expect and understand their financial responsibilities. Assumes clinical and financial risk of the organization when collecting and documenting information on behalf of the patient.

• Conducts scheduling and preregistration functions, validates patient demographic data, identifies and verifies medical benefits, accurate plan code, and COB order. Obtains limited clinical data based on service required. Corrects and updates all necessary data to assure timely, accurate bill submission.
• Verifies insurance information through payor contacts via telephone, online resources, or electronic verification system.
• Identifies payor authorization/referral requirements and provides appropriate documentation and follow‑up to physician offices, case‑management department, and payors regarding authorization/referral deficiencies.
• Identifies all patient financial responsibilities, calculates estimates, collects liabilities, posts payment transactions as appropriate in the ADT system, and performs daily reconciliation. Identifies self‑pay and complex liability calculations and escalates account to Financial Counselors as appropriate.
• Delivers positive patient experience.
• Cooperates with and maintains excellent working relationships with patients, AHN leadership and staff, physician offices, and designated external agencies or vendors. Performs any written or verbal communication necessary to exchange information with designated contacts and promote working relationships.
• Maintains focus on attaining productivity standards, recommending innovative approaches for enhancing performance and productivity when appropriate.
• Adheres to AHN organizational policies and procedures for relevant location and job scope.
• Completes and/or attends mandatory training and education sessions within approved organizational guidelines and time frames.
• Performs other duties as assigned or required.

• Minimum:
  High school diploma or GED; or one to three months of related experience and/or training; or an equivalent combination of education and experience.
• One previous year of related experience, preferably within a medical setting, financial services setting, and/or a demanding customer service environment.
• Experience operating a PC and using software applications.
• Preferred medical terminology knowledge and experience obtaining insurance verifications.
• Call/Service Center experience.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

This job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. Employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. All employees must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures, as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct, applicable federal and state laws, rules, and regulations, and company policies and training requirements.