Patient Access Advocate-Senior

Now hiring a Patient Access Advocate Senior

The Senior Patient Access Advocate provides all services needed to resolve the financial clearance of patient accounts of government and commercial accounts prior to billing. Performs all financial clearance functions, including insurance verification, authorization, collection and documentation of patient demographics, quality assurance of registration data, benefit analysis, financial counseling, and pre and post service collections. Ensure follow up on authorizations for scheduled and Urgent/Emergent procedures and admissions that were not obtained prior to discharge. Possess a strong knowledge of Medicare (CMS) guidelines, as well as other Compliance Regulatory guidelines applicable to Patient Access. Address work queues for claim edits, bill holds and missing authorizations ensuring a clean claim for billing. Identifying and reporting out registration and clinical trends. Identify functional issues and report them. Act as a departmental resource for Patient Access Representatives with implementation of new processes, programs and projects.

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community.

 

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

• Full Time - Exempt: No
• Job is based Rev Hugh Cooper Admin Center
• Work hours: Days
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.

Ideal Candidate: 5 years experience in healthcare setting with 2 years of Patient Access and/or billing plus strong customer service background.

• High school diploma/GED
• Internal Candidates: 5 years experience in healthcare setting with 2 years of Patient Access and/or billing plus strong customer service background.
• Previously passed Patient Access Advocate II, III and Specialist Advancement tests.
• CHAA, CHAM or other industry equivalent certification preferred
• Expert knowledge of insurance and financial processing of accounts;
• Expert knowledge of medical terminology and billing codes (DRG, ICD-10, CPT, HCPCS);
• Proficient in EPIC ADT system; include scheduling, registration, contract requirements, financial guidelines, coordination of services and billing process.
• Proficient in Microsoft Office Products.

Customer Service and Caring Practices:

•  Achieve exceptional patient experience for patients and patient families by using CARES, AIDET and EPE tools.
• Addresses and attempts to appropriately resolve complaints in the moment by using key words at key times and de-escalation processes.
• Ability to manage conflict and appropriately request the help of a supervisor when needed.
• Implement PROMISE and CARES behaviors in every encounter.
• Educates patients for whom they speak regarding insurance benefits.
• Ensures accounts are cleared for billing to alleviate patient concerns over hospital financial matters 

 

• Encounter Components
• Performs the patient registration process. Manage the accurate collection of patient data which includes but is not limited to;
• Obtain/confirm and enter demographic and other financial and clinical information necessary for final clearance of scheduled and Urgent/Emergent patient accounts.
• Review Urgent/Emergent admission accounts for notification, financial clearance and authorization post discharge.
• Obtain missing insurance information which can include policy number, group number, date of birth, and insurance phone number if information is missing from account.
• Verify insurance for eligibility and benefits using online electronic verification system or by contacting payer directly.
• Review and process work queues related to Patient Access to ensure claims are submitted timely and accurately, per department guidelines.
• Quality review of accounts falling within the work queues to ensure the insurance information contains accurate policy ID#s, Group Name and Numbers, Subscriber information, Authorization numbers, as well as correct payer and Coordination of benefits prior to billing.
• Obtain retro authorization for accounts in which the authorization was pending or not received prior to discharge
• Accurately document actions taken in the system of record to drive effective follow-up and ensure an accurate audit trail.
• Maintain ongoing knowledge of commercial billing requirements and payer guidelines.
• Keep current with knowledge of facility payer contracting agreements. Understand billing
• timelines and urgency in meeting all claims and filing deadlines.
• Maintain a strong knowledge of Medicare (CMS) guidelines as it relates to admissions and outpatient services. Ensuring we are in compliance with admissions forms, benefit entitlement verification, and billing requirements
• Quality check accounts relative to MSPs and other Compliance regulations. Report out inaccuracies to leadership as appropriate.
• Daily focus on attaining productivity standards; recommend new approaches for enhancing performance and productivity when appropriate.
• Monitor and track Data Quality program to ensure errors are corrected prior to final bill and
  correct accounts as necessary.
• Maintain appropriate records, files, and timely and accurate documentation in the system of record.
• Ensures bill hold and other post discharge work queues are completed timely and efficiently to reduce denials and claim holds.
• Other duties as assigned

 

• Financial Accountabilities:
• Collects identified patient financial obligation amounts including residual balance if applicable. If patient was not notified during services, call to patient to inform and ensure transparency of expected liabilities.
• Educate patients on financial assistance, charity or other programs that may be available.
• Refers as appropriate to on site Financial Advocate or to the Financial Advocacy Center
  Patient Relations
• Contact patients post encounters to complete any information missing from the account to ensure proper billing.
• Transparency with patients through communication of patient liabilities and authorization issue in a timely manner, allowing patients ability to make informed decisions.

 

 

• Quality Improvement:
• Perform assigned patient care responsibilities, which may include but not limited to:
• Cooperate fully in all risk management activities and investigations.
• Report promptly any suspected or potential violations to laws, regulations, procedures, policies, and practices, and cooperate in related investigation.
• Conduct all transactions in compliance with all company policies, procedures, standards, and practices.
• Demonstrate knowledge of all applicable compliance and legal requirements of the job based on the scope of practice of the position.
  C.A.R.E.S Behaviors:
• Demonstrates CARES behaviors of Collaborate, be Accountable, Respect, Engage and Serve to all whom you encounter.

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

Inclusion and Diversity
Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

USD $26.46/Hr.

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.