Patient Access Specialist - Austin North Campus

We are searching for a Patient Access Specialist — someone who works well in a fast-paced setting. In this position, you will ensure timely and accurate patient registration by serving as the liaison between patient/family, payers, providers, Healthcare Information Management (Medical Records), Patient Financial Services (PFS or Business Services) and other health care team members. While utilizing a unique medical record number, the Patient Access Specialist will facilitate patient tracking and billing by obtaining/verifying accurate and complete demographic information, financially securing, ensuring financial authorizations, and collecting out-of-pocket responsibility from guarantors to maximize hospital reimbursement.

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Job Duties & Responsibilities

• Obtains, verifies, and enters complete and accurate demographic information on all accounts to facilitate smooth processing through the revenue cycle. Thoroughly searches the patient accounting system for an existing medical record on each visit. Uses appropriate search techniques to ensure that no duplicate medical records are created in the master patient index. Accurately enters complete demographic information into the system. Verified information should include correct spelling of patient name, date of birth, gender, address, phone number, guarantor data, etc. Patient names should follow hospital protocol regarding middle names, suffixes, etc. Ensures assigned DARs and/or work queues are monitored and worked daily, ensuring that all elements of the accounts are secured for billing.  
• Financially secures all patient accounts to maximize hospital reimbursement in a customer service-oriented fashion. Verifies insurance benefits for all plans associated with patient, confirming the correct payor and plan is entered into EPIC. Enters patient estimates in estimating software if required. Obtains insurance referrals, as required by individual insurance plans, documenting referral numbers in the appropriate fields for accurate billing. Documents whether authorization is required and obtains clinical authorizations, as necessary. Provides estimates of patient liability to patient/guarantor prior to visit as part of financially securing the account. Involves financial counseling department for self-pay accounts requiring assistance with funding. Maximizes hospital reimbursement by collecting patient liability while providing pre-service estimates and/or at the time of service. Registers unscheduled patients as soon as notified, obtaining insurance benefits and referrals/authorizations prior to providing services.  
• Ensures financial authorization for service is obtained and to provide the authorizing entity with clinical information including diagnosis and treatment plan. References the hospital’s contractual agreements with insurance companies to obtain authorization for services. Uses communication skills to facilitate non-hospital employee compliance in providing necessary information for authorization. Obtains retro authorizations, if necessary, on accounts in which services have already been provided. Obtains clinical and financial authorization as required by contract for services. Ensures no more than three accounts greater than $1,000 each, or multiple write-offs that total $5,000 are written off due to unauthorized services. Reviews and acts to secure accounts requiring additional clinical information to extend authorization periods (extensions).  
• Facilitates provider communication with payer representative and/or payer Medical Director. Refers any denials of services or cases with questioned medical necessity to the referring physician or his/her designee for additional information. Verifies authorization requirements with payer representatives and communicates all necessary information to hospital staff. Facilitates physician-to-physician communication when applicable.  
• Provides complete and accurate documentation on each visit to ensure compliance with hospital and government regulations. Obtains signatures from patient/guarantor for release of information, general consent to treat, statement of financial responsibility, Medicare and Champus forms, and other required paperwork, as measured by account audits, medical record review, and feedback from downstream departments. Reviews and scans copy of insurance cards at the time of service, ensuring the information matches what is in the patient accounting system. Provides every patient/guarantor with information regarding their rights and responsibilities, advanced directives, and privacy notices. Documents in account notes all pertinent information required to successfully bill and collect on the claim. This includes verification/authorization information, attempts to contact family regarding patient financial liability, and collections made at the time of service. Documents each step in the authorization process from initial request to final authorization information (e.g., authorization number, applicable services dates covered by the authorization, insurance company contact, etc.). Updates referral status in EPIC during the authorization process from “Authorization Pending” to “Complete” once the authorization is obtained. Documents all interactions with referring providers and insurance companies in referral notes.  
• Provides continuous support of process improvements through compilation of data, excellent customer service, monitoring and evaluation of departmental roles, and proposals for process improvement initiatives. Constantly monitors and evaluates current role to identify aspects of services and processes that have potential for process improvement. Supports all related process improvement initiatives by collecting and compiling related data. Proposes new process improvement initiatives as appropriate. Maintains accurate statistics on own productivity as part of departmental tracking and quality improvement. Provides excellent customer service by effectively meeting customer needs, understanding who the customers are, and building quality relationships. Successfully completes all required training to ensure appropriate knowledge is maintained. Provides in-service training for departments, either in staff meetings or through individual meetings to ensure initiations are completed accurately and inform staff of any pre-authorization updates from insurance providers.

Skills & Requirements

• Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children’s unless approved for a medical or religious exemption.
• Required H.S. Diploma or GED
• 2 years Patient access registration or patient accounting experience 

About Texas Children’s