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Healthcare Coding Specialist

2401 Jefferson Building
Springfield, IL
Full-Time
Day Shift
$19.62 - $30.41

Are you a detail-oriented coding professional looking for a rewarding career in healthcare? Join Memorial Health as a...

Healthcare Coding Specialist

2401 Jefferson Building
Springfield, IL
Tracking Code 2024-21666

Position Summary

Full-Time
Day Shift
$19.62 - $30.41

Are you a detail-oriented coding professional looking for a rewarding career in healthcare? Join Memorial Health as a Healthcare Coding Associate and become an integral part of our mission to ensure accurate, efficient medical coding and optimal reimbursement. You’ll have the flexibility of remote work across multiple states (Illinois, Indiana, Kansas, Kentucky, Michigan, Missouri, Ohio, and Wisconsin), while applying your expertise in ICD-9-CM, ICD-10-CM, and CPT coding.

Why Join Us?

  • Remote Work Flexibility: Enjoy the convenience of working from home while supporting Memorial Health’s coding needs.
  • Ongoing Learning: Participate in continuing education and compliance training to stay updated on medical terminology, disease processes, and coding standards.
  • Supportive Environment: Work under the guidance of experienced Coding Supervisors and collaborate with a professional team that values Safety, Courtesy, Quality, and Efficiency.
  • Impactful Role: Your coding expertise will directly contribute to optimal reimbursement and data accuracy, helping shape the future of healthcare.

What You’ll Do:

  • Review outpatient diagnostic records and code diagnoses/procedures using ICD and CPT conventions.
  • Audit medical records for completeness and accuracy.
  • Participate in monthly coding meetings and collaborate with various medical personnel.
  • Stay updated on the latest standards and coding guidelines from leading healthcare organizations like CMS, AHIMA, and more.

If you’re ready to take the next step in your coding career while enjoying the flexibility of remote work, apply now and help Memorial Health continue to deliver top-quality patient care!

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

  • Review medical records and accurately code the principal and all secondary diagnoses and procedures using ICD-9-CM, ICD-10-CM, and/or CPT coding conventions; sequence the diagnoses and procedures using coding guidelines; abstract and compile data from medical records to assign the most appropriate codes for optimal reimbursement.
  • Coding of Outpatient Diagnostic Accounts- as assigned performs coding analysis on all outpatient diagnostic accounts utilizing 3M and/or other coding products. Abstracts all coded accounts in coding system per procedure.  Ensure an APC assignment is accurate.
  • Participates in required continuing education and compliance training programs to maintain an understanding of anatomy and physiology, medical terminology, disease processes and surgical techniques to support the effective application of ICD-9-CM, ICD-10-CM and CPT coding guidelines to outpatient diagnoses and procedures. Staff will maintain up-to-date knowledge of medical records practices, standards, regulations, Joint Commission on Accreditation of Health Organizations (JCAHO), Centers for Medicare and Medicaid (CMS), Federal Intermediary (FI) and other related organizations. 
  • Ensures compliance with all current Memorial Medical Center and department policies and procedures.
  • Embodies the Memorial Health Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency that support our mission, vision and values:
  • Demonstrates ability to cooperate with Memorial Medical Center management personnel, physicians and other persons contacted during the working day.
  • Enter and retrieve patient medical data from computer terminal updating entries as necessary; audit medical record for accuracy and completeness, note deficiencies and refer for appropriate follow up and completion.
  • Participates in monthly coding meeting with Coding Supervisors and other meetings at determined appropriate.
  • Serve as a member of designated divisional committees and other steering committees as appropriate.
  • Promotes MHS Guest Relations philosophy, Statement of Values, and follows MHS Behavior Standards and Code of Conduct.
  • Performs other related work as required or requested.

 

The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by incumbents of this job.  Incumbents may be requested to perform tasks other than those specifically presented in this description.

Required Experience

Education:

  • High School Graduate required, Associate Degree or some post-secondary education desired.

Licensure/Certification/Registry:

  • Certified Coding Associate (CCA), Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA),or Certified Professional Coder-Apprentice, successful completion of a coding program, or six months coding, health information, or relevant experience required.
  • Accredited training in Medical Terminology and Human Anatomy and Physiology required.

Experience:

  • Previous coding, health information management, physician medical office, registration or billing experience preferred.
  • Minimum typing skill of 40 WPM and/or 1 year CRT experience required.
  • Word processing/computer application experience and knowledge desired.

Other Knowledge/Skills/Abilities:

  • Demonstrates excellent knowledge of proper use of ICD-9-CM, ICD-10-CM and CPT-4 coding guidelines and principles.
  • Knowledgeable of Admission, Utilization Review, Billing and Collection process.
  • Demonstrates excellent interpersonal and communication skills.
  • Demonstrates ability to work independently.
Springfield, IL

Patient Access Specialist I

Springfield Memorial Hospital
Springfield, IL
Full-Time
Evening Shift
$16.00 - $23.64

Assists in providing access to services provided at the hospital and/or other service area. Processes registration in...

Patient Access Specialist I

Springfield Memorial Hospital
Springfield, IL
Tracking Code 2025-26939

Position Summary

Full-Time
Evening Shift
$16.00 - $23.64

Assists in providing access to services provided at the hospital and/or other service area. Processes registration information for the patient visit, obtaining patient demographic and third party information with a high degree of accuracy, and performs financial collections.  Performs the timely completion, preparation, and deployment of legal, ethical and compliance related documents that must be presented and thoroughly explained to the patient at the time of registration. Maintains knowledge of JCAHO, Patient Rights and Responsibilities, HIPAA, HMOs, Commercial Payers, and departmental / system policies and procedures. Provides Mammography Screening scheduling services to patients. Work may be performed in a patient care area. Serves as a liaison between ancillary departments and other Patient Access Services areas.       

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

  • Completes all steps of pre-registration/registration; verifies patient identity and demographic information through appropriate tools. Identifies/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.
  • Schedules patients for Mammography procedures efficiently, effectively, and according to established protocol for modality, location, facility capabilities, insurance requirements, type of exam, patient preferences, and urgency.
  • Educates patients/others regarding the resolution of billing, 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 across the enterprise, and an interdisciplinary approach to patient and organizational needs.
  • Adheres to all CMS Conditions of Participation regulations and Section 1154(e) of the Social Security Act regarding delivery, explanation, and acquisition of patient/designated representative signatures.
  • Verifies medical necessity, and obtains appropriate signature on Advance Beneficiary Notice of non-coverage (ABN) per CMS regulations at points of patient access.
  • Negotiates with patients and families to collect patient co-pays and/or deposits at point of service. Supports Patient Access Services POS (Point of Service) collection goals as defined by Revenue Cycle leadership and best practice benchmarks.
  • Triages, documents, and initiates referrals of patients to Medicaid vendor and/or for financial assistance, per the Illinois Fair Patient Billing Act, Illinois Uninsured Patient Discount Act, and established SMH procedures.
  • Identifies/reviews services requiring pre-authorization/pre-certification by Medicare, Medicaid, Commercial, and Managed Care payers, to ensure provider eligibility requirements are met prior to receiving service. Utilizes appropriate technology and/or communicates with physician offices.
  • Analyzes reports containing rejected accounts from a variety of hospital sources, including Non-Patient Access registration departments, and resolves toward verification of patient benefit eligibility, and subsequent reimbursement from all possible payer sources, or determines suitability for financial assistance.
  • Orients and cross-trains others within assigned area of responsibility as directed and defined by management. May assist other areas within the unit or department, as necessary, during times of special needs or staff absences. May be required to work night or weekend shifts.
  • Ensures compliance with all applicable HIPAA, Joint Commission, CDC, SMH, and state and federal statues, providing required associated literature to patients at all PAS access points. Educates patients regarding Advance Directives, Medicare D prescription coverage, SMH, Joint Commission, and Illinois Department of Public Health grievance process as appropriate.
  • Maintains current knowledge of, and complies with, the Illinois Fair Patient Billing Act and Illinois Uninsured Patient Discount Act at all times.
  • Completes Illinois DHS legal forms for psychiatric admits, in compliance with State of Illinois and SMH statues and guidelines. Provides relevant patient/family education.
  • May rotate work settings, i.e., patient registration, bedside registration, or other SMH campus environments. May be required to provide coverage for the SMH Financial Lobby Office.
  • Develops and maintains a comprehensive knowledge of the health system organization and its functions. Completes all assigned annual organizational education
  • Meets expectations for productivity, accuracy, and point of service collections
  • Attendance at quarterly department meetings is mandatory unless absence is approved by PAS management prior to the meeting date.
  • Performs pre-registration functions as requested.
  • Performs other related work as required or requested.

Required Experience

Education:

High School diploma required. 

Licensure/Certification/Registry:

Must successfully complete assigned annual education through Healthcare Business Insights.

Experience:

One (1) years of business office experience, preferably in the areas of Patient Access, billing, collections, insurance principles/practices, or accounts receivable. Completion of 12 (twelve) hours of coursework in a business or healthcare related field of study may be considered in lieu of business office experience. Previous experience in Patient Access is highly desirable.  

Other Knowledge/Skills/Abilities:

  • Knowledge of all tasks performed in the various Patient Access Service areas is necessary to provide optimum internal and external customer satisfaction and provide the opportunity for accurate reimbursement. 
  • Demonstrates superior patient relations and interpersonal skills; demonstrates an appropriate level of mental and emotional tolerance and even temperament when dealing with staff, patients and general public, using tact, sensitivity and sound judgment; promotes a positive work environment and contributes to the overall team efforts of the department and organization.
  • Working knowledge of computers is required, with the ability to enter and retrieve data, and electronically notate registration software, and other required applications/systems.
  • Must demonstrate detail orientation, critical thinking, and problem solving ability.
  • Must demonstrate excellent oral and written communication and customer service skills, with ability to maintain a calm and professional demeanor in high stress situations.
  • Demonstrated ability to remain flexible, and consistently exercise sound judgment and initiative in very stressful situations.
  • Ability to effectively manage competing priorities and work independently in a rapidly changing environment.
  • Must demonstrate ability to educate, persuade, and negotiate effectively with patients and families.
  • Knowledge of medical terminology, medical procedural (CPT) and diagnosis (ICD 10 CM) coding, and hospital billing claims preferred, but not required.
Springfield, IL

Patient Access Specialist I

Springfield Memorial Hospital
Springfield, IL
Part-Time
Day Shift
$16.00 - $23.64

 Monday-Friday 10:00AM – 02:00PM   Our Patient Access Specialist assists in providing access t...

Patient Access Specialist I

Springfield Memorial Hospital
Springfield, IL
Tracking Code 2024-25747

Position Summary

Part-Time
Day Shift
$16.00 - $23.64
  •  Monday-Friday 10:00AM – 02:00PM  

Our Patient Access Specialist assists in providing access to services provided at the hospital and/or other service area. Processes registration information for the patient visit, obtaining patient demographic and third party information with a high degree of accuracy, and performs financial collections.  Performs the timely completion, preparation, and deployment of legal, ethical and compliance related documents that must be presented and thoroughly explained to the patient at the time of registration. Maintains knowledge of JCAHO, Patient Rights and Responsibilities, HIPAA, HMOs, Commercial Payers, and departmental / system policies and procedures. Provides Mammography Screening scheduling services to patients. Work may be performed in a patient care area. Serves as a liaison between ancillary departments and other Patient Access Services areas.

Highlights & Benefits

  • Memorial Childcare
  • Mental Health Services
  • Growth Opportunities
  • Continuing Education
  • Local and National Discounts
  • Pet Insurance
  • Medical, Dental, Vision

Required Skills

  • Completes all steps of pre-registration/registration; verifies patient identity and demographic information through appropriate tools. Identifies/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.
  • Schedules patients for Mammography procedures efficiently, effectively, and according to established protocol for modality, location, facility capabilities, insurance requirements, type of exam, patient preferences, and urgency.
  • Educates patients/others regarding the resolution of billing, 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 across the enterprise, and an interdisciplinary approach to patient and organizational needs.
  • Adheres to all CMS Conditions of Participation regulations and Section 1154(e) of the Social Security Act regarding delivery, explanation, and acquisition of patient/designated representative signatures.
  • Verifies medical necessity, and obtains appropriate signature on Advance Beneficiary Notice of non-coverage (ABN) per CMS regulations at points of patient access.
  • Negotiates with patients and families to collect patient co-pays and/or deposits at point of service. Supports Patient Access Services POS (Point of Service) collection goals as defined by Revenue Cycle leadership and best practice benchmarks.
  • Triages, documents, and initiates referrals of patients to Medicaid vendor and/or for financial assistance, per the Illinois Fair Patient Billing Act, Illinois Uninsured Patient Discount Act, and established SMH procedures.
  • Identifies/reviews services requiring pre-authorization/pre-certification by Medicare, Medicaid, Commercial, and Managed Care payers, to ensure provider eligibility requirements are met prior to receiving service. Utilizes appropriate technology and/or communicates with physician offices.
  • Analyzes reports containing rejected accounts from a variety of hospital sources, including Non-Patient Access registration departments, and resolves toward verification of patient benefit eligibility, and subsequent reimbursement from all possible payer sources, or determines suitability for financial assistance.
  • Orients and cross-trains others within assigned area of responsibility as directed and defined by management. May assist other areas within the unit or department, as necessary, during times of special needs or staff absences. May be required to work night or weekend shifts.
  • Ensures compliance with all applicable HIPAA, Joint Commission, CDC, SMH, and state and federal statues, providing required associated literature to patients at all PAS access points. Educates patients regarding Advance Directives, Medicare D prescription coverage, SMH, Joint Commission, and Illinois Department of Public Health grievance process as appropriate.
  • Maintains current knowledge of, and complies with, the Illinois Fair Patient Billing Act and Illinois Uninsured Patient Discount Act at all times.
  • Completes Illinois DHS legal forms for psychiatric admits, in compliance with State of Illinois and SMH statues and guidelines. Provides relevant patient/family education.
  • May rotate work settings, i.e., patient registration, bedside registration, or other SMH campus environments. May be required to provide coverage for the SMH Financial Lobby Office.
  • Develops and maintains a comprehensive knowledge of the health system organization and its functions. Completes all assigned annual organizational education
  • Meets expectations for productivity, accuracy, and point of service collections
  • Attendance at quarterly department meetings is mandatory unless absence is approved by PAS management prior to the meeting date.
  • Performs pre-registration functions as requested.
  • Performs other related work as required or requested.

Required Experience

Education:

High School diploma required. 

Licensure/Certification/Registry:

Must successfully complete assigned annual education through Healthcare Business Insights.

Experience:

One (1) years of business office experience, preferably in the areas of Patient Access, billing, collections, insurance principles/practices, or accounts receivable. Completion of 12 (twelve) hours of coursework in a business or healthcare related field of study may be considered in lieu of business office experience. Previous experience in Patient Access is highly desirable.  

Other Knowledge/Skills/Abilities:

  • Knowledge of all tasks performed in the various Patient Access Service areas is necessary to provide optimum internal and external customer satisfaction and provide the opportunity for accurate reimbursement. 
  • Demonstrates superior patient relations and interpersonal skills; demonstrates an appropriate level of mental and emotional tolerance and even temperament when dealing with staff, patients and general public, using tact, sensitivity and sound judgment; promotes a positive work environment and contributes to the overall team efforts of the department and organization.
  • Working knowledge of computers is required, with the ability to enter and retrieve data, and electronically notate registration software, and other required applications/systems.
  • Must demonstrate detail orientation, critical thinking, and problem solving ability.
  • Must demonstrate excellent oral and written communication and customer service skills, with ability to maintain a calm and professional demeanor in high stress situations.
  • Demonstrated ability to remain flexible, and consistently exercise sound judgment and initiative in very stressful situations.
  • Ability to effectively manage competing priorities and work independently in a rapidly changing environment.
  • Must demonstrate ability to educate, persuade, and negotiate effectively with patients and families.
  • Knowledge of medical terminology, medical procedural (CPT) and diagnosis (ICD 10 CM) coding, and hospital billing claims preferred, but not required.
Springfield, IL

REIMBURSEMENT SPECIALIST

Memorial Health Administrative Building
Springfield, IL
Full-Time
Day Shift
$17.14 - $26.56

Creates and processes claims/invoices associated with patient care services and equipment provided via Memorial Home ...

REIMBURSEMENT SPECIALIST

Memorial Health Administrative Building
Springfield, IL
Tracking Code 2024-26196

Position Summary

Full-Time
Day Shift
$17.14 - $26.56

Creates and processes claims/invoices associated with patient care services and equipment provided via Memorial Home Services of Central Illinois, Inc. Analyzes and resolves claims/billing information and/or errors associated with private pay, commercial or governmental insurance, and other third party carriers and collects outstanding balances due. Ensures compliance with Medicare/Medicaid guidelines and Memorial Home Services of Central Illinois, Inc. organizational policies. 

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

  • Receives and examines daily reports, for assigned billing transactions, and determines which require further analysis and action. Investigates those claims with incomplete/incorrect information and resolves problems or errors to ensure complete and applicable information accompanies the claim.
  • Prioritizes billings and claims information and prepares the necessary paperwork, ensuring careful adherence to insurers’ guidelines (where applicable), timeliness, accuracy, and processing procedures. At prescribed intervals, follows up for review to ensure smooth processing and timely delivery of monetary reimbursements.
  • Analyzes ECS (Electronic Claims Submissions) reports containing rejected account information and performs the necessary research to resolve the reason(s) for the rejection and secures any other required information.
  • Investigates unpaid invoices, claim denials, and insurance correspondence to develop response or appeals to facilitate claim resolution. Contacts patients, guarantors, or other sources of third party payment as necessary to secure arrangements for payment.
  • Researches and resolves complex issues associated with billing and collection of patient accounts. As applicable, identifies, documents, and reports problematic trends to management.
  • Communicates and resolves claims issues with a variety of internal and external sources. This may include internal departments, patients (or other responsible parties), third-party payors, social service agencies, Medicare/Medicaid staff, other insurance carriers, service providers, and collection agencies.
  • Communicates with patients, via phone or mail, to request information/documentation related to claim resolution, or to respond to patient inquiries or correspondence, or to facilitate payment of outstanding balances. Meets with customers in person as requested.
  • Initiates adjustments to accounts receivables, including contractuals / allowances, within scope of expertise and authority granted. Log sheet is completed for any claim above permission levels, and supporting detail information and related documentation is attached and forwarded to the Reimbursement Manager for approval.
  • Enters account notes in online systems and electronic files to ensure accurate documentation regarding the status of billings, claims, payments, collections activities, refunds and adjustments.
  • Ensures compliance to Memorial Home Services of Central Illinois, Inc. policies, by identifying, initiating and processing accurate and timely refunds to private payers, commercial insurance, and/or governmental entities, any time an overpayment is identified.
  • Responds to requests from internal departments regarding the proper coding, billing, and processing of claims.
  • As directed and defined by management, orients and cross-trains on other unit duties that are outside of regularly assigned area of responsibility. May serve as a back up for other areas within the unit or department, especially during times of special needs or staff absences.
  • Assists with training of new Reimbursement and Customer Service staff.
  • Performs both Collections and Denial functions when necessary.
  • Participates on work teams for Quality Improvement when necessary.
  • Analyze receivable reports and follow-up on a timely basis the status of unpaid claims.
  • Communicate professionally with hospitals, physician offices, co-workers and customers as appropriate.
  • Monitor On-Hold aging claims to resolve issues/problems and facilitate timely release in accordance with department standards.
  • Performs other related work as required or requested.

Required Experience

Education:

  • Education equivalent to graduation from high school or GED is required.

Experience:

  • Two or more years of insurance and/or health care billing experience is required. Previous experience with in the home medical equipment industry or as a collector is highly preferred.

Other Knowledge/Skills/Abilities:

  • Basic working knowledge of personal computers and their associate user software is required. Experience with Microsoft Office products Word and Excel is preferred.
  • Ability to work within the guidelines of defined governmental policies and company procedures is required.
  • Demonstrated ability to work successfully with internal customers and external contacts is required.
  • Possesses a highly developed detail orientation, critical thinking, and problem solving ability.
  • Demonstrates excellent oral and written communication, customer relations, and listening skills. Must demonstrate the ability to persuade and negotiate effectively.
  • Familiarity with medical terminology, medical procedural (CPT), diagnosis (ICD-9 CM) coding and HCPCS coding is highly preferred.
Springfield, IL
New

Patient Access Specialist I

Memorial Care Urgent Care
Springfield, IL
Part-Time
Day Shift
$16.00 - $23.64

Monday-Friday 10:00AM – 02:00PM/Part Time [With Weekend Rotation]  Our Patient Access Specialist assists...

Patient Access Specialist I

Memorial Care Urgent Care
Springfield, IL
Tracking Code 2024-26446

Position Summary

Part-Time
Day Shift
$16.00 - $23.64
  • Monday-Friday 10:00AM – 02:00PM/Part Time [With Weekend Rotation] 

Our Patient Access Specialist assists in providing access to services provided at the hospital and/or other service area. Processes registration information for the patient visit, obtaining patient demographic and third party information with a high degree of accuracy, and performs financial collections.  Performs the timely completion, preparation, and deployment of legal, ethical and compliance related documents that must be presented and thoroughly explained to the patient at the time of registration. Maintains knowledge of JCAHO, Patient Rights and Responsibilities, HIPAA, HMOs, Commercial Payers, and departmental / system policies and procedures. Provides Mammography Screening scheduling services to patients. Work may be performed in a patient care area. Serves as a liaison between ancillary departments and other Patient Access Services areas.

Highlights & Benefits

  • Memorial Childcare
  • Mental Health Services
  • Growth Opportunities
  • Continuing Education
  • Local and National Discounts
  • Pet Insurance
  • Medical, Dental, Vision

Required Skills

  • Completes all steps of pre-registration/registration; verifies patient identity and demographic information through appropriate tools. Identifies/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.
  • Schedules patients for Mammography procedures efficiently, effectively, and according to established protocol for modality, location, facility capabilities, insurance requirements, type of exam, patient preferences, and urgency.
  • Educates patients/others regarding the resolution of billing, 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 across the enterprise, and an interdisciplinary approach to patient and organizational needs.
  • Adheres to all CMS Conditions of Participation regulations and Section 1154(e) of the Social Security Act regarding delivery, explanation, and acquisition of patient/designated representative signatures.
  • Verifies medical necessity, and obtains appropriate signature on Advance Beneficiary Notice of non-coverage (ABN) per CMS regulations at points of patient access.
  • Negotiates with patients and families to collect patient co-pays and/or deposits at point of service. Supports Patient Access Services POS (Point of Service) collection goals as defined by Revenue Cycle leadership and best practice benchmarks.
  • Triages, documents, and initiates referrals of patients to Medicaid vendor and/or for financial assistance, per the Illinois Fair Patient Billing Act, Illinois Uninsured Patient Discount Act, and established SMH procedures.
  • Identifies/reviews services requiring pre-authorization/pre-certification by Medicare, Medicaid, Commercial, and Managed Care payers, to ensure provider eligibility requirements are met prior to receiving service. Utilizes appropriate technology and/or communicates with physician offices.
  • Analyzes reports containing rejected accounts from a variety of hospital sources, including Non-Patient Access registration departments, and resolves toward verification of patient benefit eligibility, and subsequent reimbursement from all possible payer sources, or determines suitability for financial assistance.
  • Orients and cross-trains others within assigned area of responsibility as directed and defined by management. May assist other areas within the unit or department, as necessary, during times of special needs or staff absences. May be required to work night or weekend shifts.
  • Ensures compliance with all applicable HIPAA, Joint Commission, CDC, SMH, and state and federal statues, providing required associated literature to patients at all PAS access points. Educates patients regarding Advance Directives, Medicare D prescription coverage, SMH, Joint Commission, and Illinois Department of Public Health grievance process as appropriate.
  • Maintains current knowledge of, and complies with, the Illinois Fair Patient Billing Act and Illinois Uninsured Patient Discount Act at all times.
  • Completes Illinois DHS legal forms for psychiatric admits, in compliance with State of Illinois and SMH statues and guidelines. Provides relevant patient/family education.
  • May rotate work settings, i.e., patient registration, bedside registration, or other SMH campus environments. May be required to provide coverage for the SMH Financial Lobby Office.
  • Develops and maintains a comprehensive knowledge of the health system organization and its functions. Completes all assigned annual organizational education
  • Meets expectations for productivity, accuracy, and point of service collections
  • Attendance at quarterly department meetings is mandatory unless absence is approved by PAS management prior to the meeting date.
  • Performs pre-registration functions as requested.
  • Performs other related work as required or requested.

Required Experience

Education:

High School diploma required. 

Licensure/Certification/Registry:

Must successfully complete assigned annual education through Healthcare Business Insights.

Experience:

One (1) years of business office experience, preferably in the areas of Patient Access, billing, collections, insurance principles/practices, or accounts receivable. Completion of 12 (twelve) hours of coursework in a business or healthcare related field of study may be considered in lieu of business office experience. Previous experience in Patient Access is highly desirable.  

Other Knowledge/Skills/Abilities:

  • Knowledge of all tasks performed in the various Patient Access Service areas is necessary to provide optimum internal and external customer satisfaction and provide the opportunity for accurate reimbursement. 
  • Demonstrates superior patient relations and interpersonal skills; demonstrates an appropriate level of mental and emotional tolerance and even temperament when dealing with staff, patients and general public, using tact, sensitivity and sound judgment; promotes a positive work environment and contributes to the overall team efforts of the department and organization.
  • Working knowledge of computers is required, with the ability to enter and retrieve data, and electronically notate registration software, and other required applications/systems.
  • Must demonstrate detail orientation, critical thinking, and problem solving ability.
  • Must demonstrate excellent oral and written communication and customer service skills, with ability to maintain a calm and professional demeanor in high stress situations.
  • Demonstrated ability to remain flexible, and consistently exercise sound judgment and initiative in very stressful situations.
  • Ability to effectively manage competing priorities and work independently in a rapidly changing environment.
  • Must demonstrate ability to educate, persuade, and negotiate effectively with patients and families.
  • Knowledge of medical terminology, medical procedural (CPT) and diagnosis (ICD 10 CM) coding, and hospital billing claims preferred, but not required.
Springfield, IL
New

Patient Access Specialist I

Jacksonville Memorial Hospital
Jacksonville, IL
Part-Time
Evening Shift
$16.00 - $23.64

Assists in providing access to services provided at the hospital and/or other service area. Processes registration in...

Patient Access Specialist I

Jacksonville Memorial Hospital
Jacksonville, IL
Tracking Code 2024-26501

Position Summary

Part-Time
Evening Shift
$16.00 - $23.64

Assists in providing access to services provided at the hospital and/or other service area. Processes registration information for the patient visit, obtaining patient demographic and third party information with a high degree of accuracy, and performs financial collections.  Performs the timely completion, preparation, and deployment of legal, ethical and compliance related documents that must be presented and thoroughly explained to the patient at the time of registration. Maintains knowledge of JCAHO, Patient Rights and Responsibilities, HIPAA, HMOs, Commercial Payers, and departmental / system policies and procedures. Provides Mammography Screening scheduling services to patients. Work may be performed in a patient care area. Serves as a liaison between ancillary departments and other Patient Access Services areas.   

Highlights & Benefits

  • Memorial Childcare
  • Mental Health Services
  • Growth Opportunities
  • Continuing Education
  • Local and National Discounts
  • Pet Insurance
  • Medical, Dental, Vision

Required Skills

  • Completes all steps of pre-registration/registration; verifies patient identity and demographic information through appropriate tools. Identifies/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.
  • Schedules patients for Mammography procedures efficiently, effectively, and according to established protocol for modality, location, facility capabilities, insurance requirements, type of exam, patient preferences, and urgency.
  • Educates patients/others regarding the resolution of billing, 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 across the enterprise, and an interdisciplinary approach to patient and organizational needs.
  • Adheres to all CMS Conditions of Participation regulations and Section 1154(e) of the Social Security Act regarding delivery, explanation, and acquisition of patient/designated representative signatures.
  • Verifies medical necessity, and obtains appropriate signature on Advance Beneficiary Notice of non-coverage (ABN) per CMS regulations at points of patient access.
  • Negotiates with patients and families to collect patient co-pays and/or deposits at point of service. Supports Patient Access Services POS (Point of Service) collection goals as defined by Revenue Cycle leadership and best practice benchmarks.
  • Triages, documents, and initiates referrals of patients to Medicaid vendor and/or for financial assistance, per the Illinois Fair Patient Billing Act, Illinois Uninsured Patient Discount Act, and established SMH procedures.
  • Identifies/reviews services requiring pre-authorization/pre-certification by Medicare, Medicaid, Commercial, and Managed Care payers, to ensure provider eligibility requirements are met prior to receiving service. Utilizes appropriate technology and/or communicates with physician offices.
  • Analyzes reports containing rejected accounts from a variety of hospital sources, including Non-Patient Access registration departments, and resolves toward verification of patient benefit eligibility, and subsequent reimbursement from all possible payer sources, or determines suitability for financial assistance.
  • Orients and cross-trains others within assigned area of responsibility as directed and defined by management. May assist other areas within the unit or department, as necessary, during times of special needs or staff absences. May be required to work night or weekend shifts.
  • Ensures compliance with all applicable HIPAA, Joint Commission, CDC, SMH, and state and federal statues, providing required associated literature to patients at all PAS access points. Educates patients regarding Advance Directives, Medicare D prescription coverage, SMH, Joint Commission, and Illinois Department of Public Health grievance process as appropriate.
  • Maintains current knowledge of, and complies with, the Illinois Fair Patient Billing Act and Illinois Uninsured Patient Discount Act at all times.
  • Completes Illinois DHS legal forms for psychiatric admits, in compliance with State of Illinois and SMH statues and guidelines. Provides relevant patient/family education.
  • May rotate work settings, i.e., patient registration, bedside registration, or other SMH campus environments. May be required to provide coverage for the SMH Financial Lobby Office.
  • Develops and maintains a comprehensive knowledge of the health system organization and its functions. Completes all assigned annual organizational education
  • Meets expectations for productivity, accuracy, and point of service collections
  • Attendance at quarterly department meetings is mandatory unless absence is approved by PAS management prior to the meeting date.
  • Performs pre-registration functions as requested.
  • Performs other related work as required or requested.

Required Experience

Education:

High School diploma required. 

Licensure/Certification/Registry:

Must successfully complete assigned annual education through Healthcare Business Insights.

Experience:

One (1) years of business office experience, preferably in the areas of Patient Access, billing, collections, insurance principles/practices, or accounts receivable. Completion of 12 (twelve) hours of coursework in a business or healthcare related field of study may be considered in lieu of business office experience. Previous experience in Patient Access is highly desirable.  

Other Knowledge/Skills/Abilities:

  • Knowledge of all tasks performed in the various Patient Access Service areas is necessary to provide optimum internal and external customer satisfaction and provide the opportunity for accurate reimbursement. 
  • Demonstrates superior patient relations and interpersonal skills; demonstrates an appropriate level of mental and emotional tolerance and even temperament when dealing with staff, patients and general public, using tact, sensitivity and sound judgment; promotes a positive work environment and contributes to the overall team efforts of the department and organization.
  • Working knowledge of computers is required, with the ability to enter and retrieve data, and electronically notate registration software, and other required applications/systems.
  • Must demonstrate detail orientation, critical thinking, and problem solving ability.
  • Must demonstrate excellent oral and written communication and customer service skills, with ability to maintain a calm and professional demeanor in high stress situations.
  • Demonstrated ability to remain flexible, and consistently exercise sound judgment and initiative in very stressful situations.
  • Ability to effectively manage competing priorities and work independently in a rapidly changing environment.
  • Must demonstrate ability to educate, persuade, and negotiate effectively with patients and families.
  • Knowledge of medical terminology, medical procedural (CPT) and diagnosis (ICD 10 CM) coding, and hospital billing claims preferred, but not required.
Jacksonville, IL
New

Patient Access Specialist I - PRN

Springfield Memorial Hospital
Springfield, IL
PRN
Varies Shift
$16.00 - $23.64

Assists in providing access to services provided at the hospital and/or other service area. Processes registration in...

Patient Access Specialist I - PRN

Springfield Memorial Hospital
Springfield, IL
Tracking Code 2025-26822

Position Summary

PRN
Varies Shift
$16.00 - $23.64

Assists in providing access to services provided at the hospital and/or other service area. Processes registration information for the patient visit, obtaining patient demographic and third party information with a high degree of accuracy, and performs financial collections.  Performs the timely completion, preparation, and deployment of legal, ethical and compliance related documents that must be presented and thoroughly explained to the patient at the time of registration. Maintains knowledge of JCAHO, Patient Rights and Responsibilities, HIPAA, HMOs, Commercial Payers, and departmental / system policies and procedures. Provides Mammography Screening scheduling services to patients. Work may be performed in a patient care area. Serves as a liaison between ancillary departments and other Patient Access Services areas.            

  • PRN

Highlights & Benefits

Required Skills

  • Completes all steps of pre-registration/registration; verifies patient identity and demographic information through appropriate tools. Identifies/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.
  • Schedules patients for Mammography procedures efficiently, effectively, and according to established protocol for modality, location, facility capabilities, insurance requirements, type of exam, patient preferences, and urgency.
  • Educates patients/others regarding the resolution of billing, 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 across the enterprise, and an interdisciplinary approach to patient and organizational needs.
  • Adheres to all CMS Conditions of Participation regulations and Section 1154(e) of the Social Security Act regarding delivery, explanation, and acquisition of patient/designated representative signatures.
  • Verifies medical necessity, and obtains appropriate signature on Advance Beneficiary Notice of non-coverage (ABN) per CMS regulations at points of patient access.
  • Negotiates with patients and families to collect patient co-pays and/or deposits at point of service. Supports Patient Access Services POS (Point of Service) collection goals as defined by Revenue Cycle leadership and best practice benchmarks.
  • Triages, documents, and initiates referrals of patients to Medicaid vendor and/or for financial assistance, per the Illinois Fair Patient Billing Act, Illinois Uninsured Patient Discount Act, and established SMH procedures.
  • Identifies/reviews services requiring pre-authorization/pre-certification by Medicare, Medicaid, Commercial, and Managed Care payers, to ensure provider eligibility requirements are met prior to receiving service. Utilizes appropriate technology and/or communicates with physician offices.
  • Analyzes reports containing rejected accounts from a variety of hospital sources, including Non-Patient Access registration departments, and resolves toward verification of patient benefit eligibility, and subsequent reimbursement from all possible payer sources, or determines suitability for financial assistance.
  • Orients and cross-trains others within assigned area of responsibility as directed and defined by management. May assist other areas within the unit or department, as necessary, during times of special needs or staff absences. May be required to work night or weekend shifts.
  • Ensures compliance with all applicable HIPAA, Joint Commission, CDC, SMH, and state and federal statues, providing required associated literature to patients at all PAS access points. Educates patients regarding Advance Directives, Medicare D prescription coverage, SMH, Joint Commission, and Illinois Department of Public Health grievance process as appropriate.
  • Maintains current knowledge of, and complies with, the Illinois Fair Patient Billing Act and Illinois Uninsured Patient Discount Act at all times.
  • Completes Illinois DHS legal forms for psychiatric admits, in compliance with State of Illinois and SMH statues and guidelines. Provides relevant patient/family education.
  • May rotate work settings, i.e., patient registration, bedside registration, or other SMH campus environments. May be required to provide coverage for the SMH Financial Lobby Office.
  • Develops and maintains a comprehensive knowledge of the health system organization and its functions. Completes all assigned annual organizational education
  • Meets expectations for productivity, accuracy, and point of service collections
  • Attendance at quarterly department meetings is mandatory unless absence is approved by PAS management prior to the meeting date.
  • Performs pre-registration functions as requested.
  • Performs other related work as required or requested.

Required Experience

Education:

High School diploma required. 

Licensure/Certification/Registry:

Must successfully complete assigned annual education through Healthcare Business Insights.

Experience:

One (1) years of business office experience, preferably in the areas of Patient Access, billing, collections, insurance principles/practices, or accounts receivable. Completion of 12 (twelve) hours of coursework in a business or healthcare related field of study may be considered in lieu of business office experience. Previous experience in Patient Access is highly desirable.  

Other Knowledge/Skills/Abilities:

  • Knowledge of all tasks performed in the various Patient Access Service areas is necessary to provide optimum internal and external customer satisfaction and provide the opportunity for accurate reimbursement. 
  • Demonstrates superior patient relations and interpersonal skills; demonstrates an appropriate level of mental and emotional tolerance and even temperament when dealing with staff, patients and general public, using tact, sensitivity and sound judgment; promotes a positive work environment and contributes to the overall team efforts of the department and organization.
  • Working knowledge of computers is required, with the ability to enter and retrieve data, and electronically notate registration software, and other required applications/systems.
  • Must demonstrate detail orientation, critical thinking, and problem solving ability.
  • Must demonstrate excellent oral and written communication and customer service skills, with ability to maintain a calm and professional demeanor in high stress situations.
  • Demonstrated ability to remain flexible, and consistently exercise sound judgment and initiative in very stressful situations.
  • Ability to effectively manage competing priorities and work independently in a rapidly changing environment.
  • Must demonstrate ability to educate, persuade, and negotiate effectively with patients and families.
  • Knowledge of medical terminology, medical procedural (CPT) and diagnosis (ICD 10 CM) coding, and hospital billing claims preferred, but not required.
Springfield, IL

Insurance Pre-Auth Spec I

2401 Jefferson Building
Springfield, IL
Full-Time
Day Shift
$16.00 - $23.64

A Insurance Pre-Authorization Specialist reviews all DMH and Memorial Care scheduled inpatient and outpatient procedu...

Insurance Pre-Auth Spec I

2401 Jefferson Building
Springfield, IL
Tracking Code 2025-26592

Position Summary

Full-Time
Day Shift
$16.00 - $23.64

A Insurance Pre-Authorization Specialist reviews all DMH and Memorial Care scheduled inpatient and outpatient procedures and outpatient diagnostic services to validate the scheduled procedure or diagnostic service has the appropriate payor authorization or meets the payor’s medical policies, there is a valid physician order, and other clinical documentation requirements are met prior to the scheduled procedure or diagnostic service. Coordinates physician referrals on patient accounts deemed appropriate  for additional services. Schedules, coordinates and pre-authorizes needed services ordered by the physicians.    

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

  • Understands and applies payor prior-authorization requirements, and stays current with payor changes.
  • Interacts effectively with physicians and/or office staff when receiving information regarding hospital outpatient diagnostic services and referrals services needed.
  • Provides information and assistance for Utilization Review and Patient Financial Services.
  • Primary function is to receive and coordinate pre-authorizations/RQI’s on patient accounts for all outpatient services and schedule inpatient admissions.
  • Coordinates physician referrals on patient accounts deemed appropriate for additional services. Schedules, coordinates and pre-authorizes needed services ordered by the physicians.
    • Coordinates phone calls in a positive and professional manner to meet departmental goals.
    • Prioritizes scheduled patients in accordance with managed care pre-auth requirements and medical necessity requirements.
    • Utilizes the account note function to record all telephone conversations, consultations, pertinent case specific information, and rationale for decision on cases, all reference numbers and authorization information.
    • Provides excellent customer service by adhering to quality standards and case management/confidentiality policy and procedures.
    • Communicates daily with appropriate parties for prior approval on patient accounts (case management or nurses at doctor’s offices).
    • Maintains/documents accurate record of insurance/pre-auth company information.
  • Communicates barriers or process improvement opportunities to management.
  • Assists in training new personnel or in implementing new procedures.
  • Performs other duties as assigned.

Required Experience

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required. 

  • Must possess good communication and interpersonal relationship skills.
  • Must be able to organize work with minimal supervision.
  • Must be able to focus attention to minute details.
  • Above average computer skills including Word, Excel and software applications required.

 

General Skill Requirements

In addition to the Essential Functions and Qualifications listed above, to perform the job successfully an individual must also possess the following General Skill Requirements.

  • Adaptability – Adapts to changes in the work environment; Manages competing demands; Accepts criticism and feedback; Changes approach or method to best fit the situation; ability to work with frustrating situations; work under pressure and on an irregular schedule such as unscheduled overtime, unanticipated changes in work pace; Works with numerous distractions.
  • Attendance and Punctuality – Schedules time off in advance; Begins working on time; Keeps absences within guidelines; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.
  • Communications – Expresses ideas and thoughts verbally; expresses ideas and thoughts in written form; Exhibits good listening and comprehension; Keeps others adequately informed; Selects and uses appropriate communication methods.
  • Cooperation – Establishes and maintains effective relations; Exhibits tact and consideration; Displays positive outlook and pleasant manner; Offers assistance and support to co-workers; Works cooperatively in group situations; Works actively to resolve conflicts.
  • Job Knowledge – Competent in required job skills and knowledge; Exhibits ability to learn and apply new skills; Keeps abreast of current developments; Requires minimal supervision; Displays understanding of how job relates to others; Uses resources effectively.
  • Judgment – displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions; ability to work with and maintain confidential information.
  • Problem solving – Identifies problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Resolves problems in early stages; Works well in group problem solving situations.
  • Quality – Demonstrates accuracy and thoroughness; Displays commitment to excellence; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
  • Quantity – Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly; Achieves established goals.
  • Concentration – Maintains attention to detail over extended period of time; continually aware of variations in changing situations.
  • Supervision – ability to perform work independently or with minimal supervision; ability to assign and/or review work; train and/or evaluate other employees.

Education and/or Other Requirements

  • Previous experience in customer service
  • High school education or GED.
  • Knowledge of medical service coding preferred
  • Familiarity with medical terminology or willingness to learn.

Environmental Factors

This position is performed within an environment of minimal exposure to irritating, unpleasant, or hazardous elements or conditions.

Physical Demands

The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this job.

  • While performing the duties of this job, the employee is regularly required to sit and move through an office environment.

Mental Demands

  • While performing the duties of this job, the employee must be able to work under stress, adapt to changing conditions, and meet strict time guidelines.
  • Ability to adhere to strict confidentiality requirements.
Springfield, IL

Patient Access Specialist I

Jacksonville Memorial Hospital
Jacksonville, IL
Part-Time
Day Shift
$16.00 - $23.64

Patient Registration: Collecting patient demographic and insurance information accurately, ensuring all necessary d...

Patient Access Specialist I

Jacksonville Memorial Hospital
Jacksonville, IL
Tracking Code 2025-27003

Position Summary

Part-Time
Day Shift
$16.00 - $23.64
  • Patient Registration: Collecting patient demographic and insurance information accurately, ensuring all necessary details are entered into the system for the visit.

  • Financial Collection: Handling the collection of any payments due at the time of registration, which could involve verifying insurance or discussing financial obligations with patients.

  • Legal and Compliance: Preparing and explaining legal, ethical, and compliance-related documents to patients during the registration process, ensuring that they understand their rights and responsibilities.

  • Knowledge of Healthcare Regulations: Familiarity with various healthcare regulations such as JCAHO (Joint Commission on Accreditation of Healthcare Organizations), HIPAA (Health Insurance Portability and Accountability Act), and understanding the policies related to different insurance plans (HMOs, Commercial Payers).

  • Mammography Screening: Coordinating the scheduling of mammography screenings, which might involve working with the patients directly and ensuring they are scheduled for appropriate services.

  • Interdepartmental Liaison: Acting as a bridge between different departments within the hospital or healthcare facility to ensure seamless access to services.

  • Shift and Schedule: This position is part-time and requires early hours from 4:00 AM to 10:30 AM with every other weekend.

Highlights & Benefits

  • Memorial Childcare
  • Mental Health Services
  • Growth Opportunities
  • Continuing Education
  • Local and National Discounts
  • Pet Insurance
  • Medical, Dental, Vision

Required Skills

  • Completes all steps of pre-registration/registration; verifies patient identity and demographic information through appropriate tools. Identifies/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.
  • Schedules patients for Mammography procedures efficiently, effectively, and according to established protocol for modality, location, facility capabilities, insurance requirements, type of exam, patient preferences, and urgency.
  • Educates patients/others regarding the resolution of billing, 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 across the enterprise, and an interdisciplinary approach to patient and organizational needs.
  • Adheres to all CMS Conditions of Participation regulations and Section 1154(e) of the Social Security Act regarding delivery, explanation, and acquisition of patient/designated representative signatures.
  • Verifies medical necessity, and obtains appropriate signature on Advance Beneficiary Notice of non-coverage (ABN) per CMS regulations at points of patient access.
  • Negotiates with patients and families to collect patient co-pays and/or deposits at point of service. Supports Patient Access Services POS (Point of Service) collection goals as defined by Revenue Cycle leadership and best practice benchmarks.
  • Triages, documents, and initiates referrals of patients to Medicaid vendor and/or for financial assistance, per the Illinois Fair Patient Billing Act, Illinois Uninsured Patient Discount Act, and established SMH procedures.
  • Identifies/reviews services requiring pre-authorization/pre-certification by Medicare, Medicaid, Commercial, and Managed Care payers, to ensure provider eligibility requirements are met prior to receiving service. Utilizes appropriate technology and/or communicates with physician offices.
  • Analyzes reports containing rejected accounts from a variety of hospital sources, including Non-Patient Access registration departments, and resolves toward verification of patient benefit eligibility, and subsequent reimbursement from all possible payer sources, or determines suitability for financial assistance.
  • Orients and cross-trains others within assigned area of responsibility as directed and defined by management. May assist other areas within the unit or department, as necessary, during times of special needs or staff absences. May be required to work night or weekend shifts.
  • Ensures compliance with all applicable HIPAA, Joint Commission, CDC, SMH, and state and federal statues, providing required associated literature to patients at all PAS access points. Educates patients regarding Advance Directives, Medicare D prescription coverage, SMH, Joint Commission, and Illinois Department of Public Health grievance process as appropriate.
  • Maintains current knowledge of, and complies with, the Illinois Fair Patient Billing Act and Illinois Uninsured Patient Discount Act at all times.
  • Completes Illinois DHS legal forms for psychiatric admits, in compliance with State of Illinois and SMH statues and guidelines. Provides relevant patient/family education.
  • May rotate work settings, i.e., patient registration, bedside registration, or other SMH campus environments. May be required to provide coverage for the SMH Financial Lobby Office.
  • Develops and maintains a comprehensive knowledge of the health system organization and its functions. Completes all assigned annual organizational education
  • Meets expectations for productivity, accuracy, and point of service collections
  • Attendance at quarterly department meetings is mandatory unless absence is approved by PAS management prior to the meeting date.
  • Performs pre-registration functions as requested.
  • Performs other related work as required or requested.

Required Experience

Education:

High School diploma required. 

Licensure/Certification/Registry:

Must successfully complete assigned annual education through Healthcare Business Insights.

Experience:

One (1) years of business office experience, preferably in the areas of Patient Access, billing, collections, insurance principles/practices, or accounts receivable. Completion of 12 (twelve) hours of coursework in a business or healthcare related field of study may be considered in lieu of business office experience. Previous experience in Patient Access is highly desirable.  

Other Knowledge/Skills/Abilities:

  • Knowledge of all tasks performed in the various Patient Access Service areas is necessary to provide optimum internal and external customer satisfaction and provide the opportunity for accurate reimbursement. 
  • Demonstrates superior patient relations and interpersonal skills; demonstrates an appropriate level of mental and emotional tolerance and even temperament when dealing with staff, patients and general public, using tact, sensitivity and sound judgment; promotes a positive work environment and contributes to the overall team efforts of the department and organization.
  • Working knowledge of computers is required, with the ability to enter and retrieve data, and electronically notate registration software, and other required applications/systems.
  • Must demonstrate detail orientation, critical thinking, and problem solving ability.
  • Must demonstrate excellent oral and written communication and customer service skills, with ability to maintain a calm and professional demeanor in high stress situations.
  • Demonstrated ability to remain flexible, and consistently exercise sound judgment and initiative in very stressful situations.
  • Ability to effectively manage competing priorities and work independently in a rapidly changing environment.
  • Must demonstrate ability to educate, persuade, and negotiate effectively with patients and families.
  • Knowledge of medical terminology, medical procedural (CPT) and diagnosis (ICD 10 CM) coding, and hospital billing claims preferred, but not required.
Jacksonville, IL

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