Patient Access Specialist

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

📋 Description

• Review, validate, and complete any missing registration and insurance details on electronically received encounters.

• Adjust and rectify billing information in accordance with insurance carrier requirements and company policies.

• Manage a variety of client accounts based on assigned volume and productivity goals.

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

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

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

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

• Maintain a minimum accuracy rate of 95%.

• Resolve Level 2 escalations from the offshore team and identify issues hindering claim submission.

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

• Process work within two business days and inform the supervisor when targets are not met.

• Accurately complete daily production records on time.

• Communicate any workflow deviations and escalate issues that may impact daily submissions or month-end close.

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

• Engage in training, updates, and process enhancements.

• Uphold confidentiality of sensitive information and adhere to HIPAA and company policies.

• Carry out other related duties as assigned.

⛳️ Requirements

• Strong attention to detail and accuracy, with the capability to identify discrepancies in demographic and insurance data.

• Ability to interpret eligibility files and comprehend payer requirements, rules, and coverage limitations.

• Knowledge of various insurance types, payer hierarchy, and coordination of benefits.

• Capacity to work independently with minimal supervision, manage stress, and meet set deadlines.

• Proficient in computer skills, particularly with Microsoft Office (Excel required).

• Excellent communication skills for effective collaboration with internal teams and external partners.

• Ability to prioritize tasks and manage competing responsibilities.

• Understanding of HIPAA and the handling of Protected Health Information (PHI).

• Critical thinking and problem-solving skills to identify root causes of errors and determine suitable corrective actions.

• High School Graduate or GED.

• A minimum of one year of experience in the healthcare industry.

• Experience with Athena IDX is a plus.

• Preferred qualifications include Insurance data entry or Medical Front office training and/or Certification.

🏝️ Benefits

• Opportunity for professional growth and development.

• Comprehensive health and wellness benefits.

• Supportive work environment and team collaboration.