Patient Access Specialist I

Position Summary

Highlights & Benefits

• Paid Time Off (PTO)
• Memorial Childcare
• Mental Health Services
• Growth Opportunities
• Continuing Education
• Local and National Discounts
• Pet Insurance
• Medical, Dental, Vision
• Flexible Spending Account
• 401(k)
• Life Insurance and Voluntary Benefits
• Employee Assistance Program and Colleague Wellness
• Adoption Assistance

Required Skills

Job Responsibilities

• Completes all steps of pre-registration and registration; verifies patient identity and demographic information through appropriate tools.
• Identifies and captures appropriate health insurance benefit eligibility based on contract/regulatory differentiation.
• Facilitates appropriate billing of claims and hospital reimbursement.
• Obtains and validates proper consent for patient treatment.

Scheduling & Patient Coordination

• Schedules patients for Mammography procedures efficiently and effectively according to established protocol, including modality, location, facility capabilities, insurance requirements, type of exam, patient preferences, and urgency.

Patient Education & Financial

• Educates patients and others regarding resolution of billing issues, private pay options, collection efforts, coordination of benefits, third-party and governmental payment criteria, insurance coverage, payments, and denials.
• May serve as a liaison between external resources and patients on issues requiring SMH involvement.
• Coordinates with SMH Patient Financial Services, Utilization Management, physicians, and medical offices to ensure consistent financial documentation and an interdisciplinary approach to patient and organizational needs.
• Negotiates with patients and families to collect co-pays and/or deposits at point of service and supports Patient Access Services (POS) collection goals as defined by Revenue Cycle leadership and best practice benchmarks.

Compliance & Regulatory Requirements

• Adheres to CMS Conditions of Participation regulations and Section 1154(e) of the Social Security Act regarding delivery, explanation, and acquisition of patient or representative signatures.
• Verifies medical necessity and obtains appropriate signature on Advance Beneficiary Notice of Non-Coverage (ABN) per CMS regulations at point of patient access.
• Ensures compliance with HIPAA, Joint Commission, CDC, SMH, and all applicable state and federal statutes, providing required literature at all Patient Access Service access points.
• Educates patients regarding Advance Directives, Medicare Part D prescription coverage, SMH, Joint Commission, and Illinois Department of Public Health grievance processes as appropriate.
• Maintains current knowledge of and compliance with the Illinois Fair Patient Billing Act and Illinois Uninsured Patient Discount Act.

Financial Clearance, Insurance & Authorization

• Triages, documents, and initiates referrals to Medicaid vendors and/or financial assistance programs per applicable Illinois laws and SMH procedures.
• Identifies and reviews services requiring pre-authorization or pre-certification by Medicare, Medicaid, Commercial, and Managed Care payers to ensure eligibility requirements are met prior to service; communicates with physician offices and uses appropriate technology.
• Analyzes rejected account reports from hospital sources, including Non-Patient Access registration departments, to resolve eligibility issues, secure reimbursement, or determine financial assistance eligibility.

Operational Support & Additional Duties

• Orients and cross-trains others within assigned area of responsibility as directed by management.
• Assists other areas within the unit or department during times of special need or staffing shortages.
• May be required to work night or weekend shifts.
• May rotate work settings, including patient registration, bedside registration, and other SMH campus environments.
• May provide coverage for the SMH Financial Lobby Office.
• Develops and maintains comprehensive knowledge of the health system organization and completes all assigned annual organizational education.
• Meets expectations for productivity, accuracy, and point-of-service collections.
• Attends quarterly department meetings unless absence is approved by management in advance.
• Performs pre-registration functions as requested.
• Performs other related duties as required or assigned.

Required Experience

Education

• High School Diploma required.

Licensure / Certification / Registry

• Must successfully complete assigned annual education through Healthcare Business Insights.

Experience

• Minimum of one (1) year of business office experience preferred, including:
  • Patient Access
  • Billing and collections
  • Insurance principles and practices
  • Accounts receivable
• Completion of twelve (12) hours of coursework in a business or healthcare-related field may substitute for business office experience.
• Previous Patient Access experience strongly preferred.

Knowledge, Skills, and Abilities

• Comprehensive understanding of Patient Access Service functions to support accurate registration and reimbursement processes.
• Strong interpersonal and patient relations skills with demonstrated professionalism, tact, and sensitivity when interacting with patients, families, staff, and the public.
• Ability to maintain emotional composure and professionalism in fast-paced or high-stress environments.
• Proficient computer skills including data entry, electronic documentation, and use of registration software and healthcare systems.
• Excellent attention to detail with strong critical thinking and problem-solving abilities.
• Effective oral and written communication skills with exceptional customer service focus.
• Demonstrated flexibility, sound judgment, and initiative when managing competing priorities.
• Ability to work independently while contributing positively to team and organizational goals.
• Skilled in patient education, persuasion, and negotiation related to financial and registration processes.
• Knowledge of medical terminology, CPT procedural coding, ICD-10-CM diagnosis coding, and hospital billing claims preferred but not required.