Patient Access Specialist

This is a fully remote position, open to applicants in California.

📋 Description

• Review, validate, and finalize any missing registration and insurance details for electronically received encounters.

• Implement and adjust billing information in accordance with insurance carrier guidelines and company policies.

• Oversee multiple client accounts based on assigned workload and productivity standards.

• Track and report low volumes, absent service dates, and missing insurance or payer details.

• Utilize the RICA coding application and AthenaIDX to amend and update demographic records.

• Address demographic, insurance, and Patient Access-related discrepancies, edits, and denials.

• Perform verification checks and assign correct payer information to facilitate timely billing.

• Take responsibility for Level 2 escalations from the offshore team and resolve issues that hinder claim submission.

• Provide insights and trending observations to the PA & EDI Supervisor.

• Process work within a two-business-day timeframe and inform the supervisor if targets are not being met.

• Accurately complete daily production records in a timely manner.

• Communicate deviations in workflow and escalate issues impacting daily submissions or month-end closings.

• Collaborate with Billing, Coding, Enrollment, EDI, and Leadership teams.

• Engage in training, process enhancements, and ensure compliance with payer guidelines and internal workflows.

• Follow company policies, maintain safe work practices, uphold confidentiality, and adhere to business standards.

⛳️ Requirements

• High school diploma or GED is mandatory.

• At least one year of experience in the healthcare sector is required.

• Exceptional attention to detail and accuracy.

• Capability to interpret eligibility files and comprehend payer requirements, regulations, and coverage limitations.

• Understanding of different insurance types, payer hierarchy, and coordination of benefits.

• Ability to work autonomously with minimal oversight, manage stress, and meet deadlines.

• Proficient in computer usage and Microsoft Office, particularly Excel.

• Strong communication skills necessary for collaboration with internal teams and external partners.

• Ability to prioritize tasks and manage competing responsibilities.

• Familiarity with HIPAA regulations and handling of Protected Health Information (PHI).

• Strong critical thinking and problem-solving skills.

• Experience with Athena IDX is an advantage.

• Preferred background in insurance data entry or medical front office training and/or certification.

🏝️ Benefits

• Continuous training, updates, and opportunities for process improvements.