Patient Access Specialist

Location (Fresno Area):

  • Reedley – Manning Site
  • Reedley – Women’s Site
  • Fresno – Merced Ave. Site
  • Fresno – Women’s Site (First Street)

Job Summary:           Facilitates timely access to care by ensuring patient eligibility and benefits are verified prior to services. Works with health plans to transfer patients to Omni Family Health (OFH) and obtain prior authorization for services when required. Performs check out function and reconciles scheduled appointments with posted charges on a daily basis. Responsible for correcting claims and posting errors. Has knowledge of commonly used medical terms and procedures.

Job Duties:

  1. Verify eligibility and benefits for scheduled patients and same-day appointments according to OFH policy.
  2. Work with Omni staff and health plans to assist patients with switching patients to an OFH provider (PCP).
  3. Resolve registration and authorization issues prior to patient visit. Obtain authorizations for pre-determined procedures when required. Ensure all information required to complete the billing process is obtained prior to patient checkout.
  4. Update patient account to indicate pertinent information required for billing. Review RTS manager daily to correct errors identified prior to patient visit.
  5. Assist patients with identifying the appropriate “Financial Assistance Program” within OFH that meets their needs. Coordinates these needs with Health Center leadership, scheduling & Navigators.
  6. Research documentation with physician and/or other medical personnel if clarification is required. Maintains an effective working relationship with OFH providers and Health Center leadership.
  7. Post charges for completed encounters during checkout.
  8. All other related duties as directed by the Billing Supervisor.

 Additional Duties:

  1. HIPAA compliance – Responsible for maintaining abreast of and in compliance with all HIPAA regulations and requirements. Treats all member information confidential.
  2. Compliance – Ensure compliance with all local, state and federal regulations.
  3. QA/QI – Participate in QA/QI activities and contribute towards the overall performance improvement of the organization.
  4. IT – Required to learn and use the Electronic Health Record and Practice Electronic System) and its components. As required by the job functions and highlighted in the Policies and Procedures. These components include NextGen, PMS, QSI and other electronic features, as they are developed and implemented, as applicable to work environment.
  5. All employees will participate in Patient Centered Health Home Model at Omni Family Health.

Qualifications, Education, and Experience:

Education:

  • Minimum High school graduate or GED.

Experience:

  • Minimum of two year’s experience in handling billing and account receivables in a similar healthcare environment.

License/Certification:

  • N/A

Skills/Competency:

  • Working knowledge of coding rules, regulations, and third party payer requirements preferred.
  • Must possess good customer service skills and professionalism to interact with internal and external customers, patients and staff.
  • Ability to work under pressure.
  • Ability to handle multiple functions.
  • Understanding of community based organizations.
  • Ability to demonstrate effective communication skills (verbal, nonverbal, written) with the medical/dental staff and Office managers.
  • Ability to work proficiently and efficiently in a timely manner.
  • Ability to problem-solve and make decisions consistent with organizational policies and procedures
  • Able to work independently, demonstrating effective initiative, follow-through, organizational skills
  • Knowledge of all payer codes.
  • Knowledge of State and County programs offered by OFH.
  • Ability to relate to the public regardless of ethnic, religion and economic status.

Responsible To:  Billing Supervisor

Classification:  Full or Part Time, Non-exempt