PATIENT ACCESS ASSOCIATE II

The Patient Access Associate II for the Electrographic Service Line at Riverside Healthcare is responsible for registering, scheduling, and verifying insurance/Medicare/Medicaid compliance while delivering exceptional customer service. This role requires strong organizational skills, the ability to work independently in a fast-paced environment, and a compassionate approach to patient interaction. The Patient Access Associate II plays a critical role in ensuring a smooth revenue cycle process by accurately collecting and analyzing patient demographic, insurance, and clinical data, securing payment authorization, and resolving discrepancies in collaboration with various departments. Demonstrates flexibility with assignments within professional scope/duties/licensure.

Essential Duties

Patient Registration & Scheduling:

• Efficiently register and schedule patients, ensuring accurate collection of demographic, insurance, and clinical data across all payer classes.
• Preregister appointments during scheduling whenever possible to facilitate smooth patient processing and timely insurance verification.
• Provide patients with clear instructions for tests, procedures, and treatment locations, optimizing their schedules for convenience and continuity of care.

Insurance & Compliance Verification:

• Screen for compliance with payer requirements, including medical necessity, precertification, and third-party eligibility.
• Complete benefit verification for all insurance types, including Medicare and Medicaid, ensuring the accuracy of information to secure payments.
• Adhere to EMTALA, HIPAA, payer, and other applicable regulations during the registration process.  

Customer Service & Communication:

• Greet patients and their representatives with courtesy and compassion, identifying yourself and guiding them through the registration process.
• Maintain effective communication with patients and families, ensuring they understand all steps and addressing any delays.
• Listen and respond to patient inquiries, providing appropriate guidance or redirecting calls as necessary.  

Data Accuracy & Documentation:

• Accurately collect, analyze, and electronically record all necessary demographic, financial, and clinical data for billing and compliance purposes.
• Review previously recorded patient information to identify discrepancies and resolve them by reverifying payer details and medical necessity.
• Provide thorough and timely documentation of all patient interactions, ensuring records are accurate and up to date.

Work Flow Management & Prioritization:

• Assess work flow priorities to respond to incoming calls and outstanding orders in a timely manner.
• Monitor call volumes using appropriate software, adjusting staffing levels to meet departmental needs.
• Attend all mandatory education sessions and departmental meetings to stay informed about best practices and procedural updates.

Non-essential Duties

• Stay updated on regulatory compliance changes, including payer regulations and HIPAA Privacy and Security requirements.
• Assist with special projects as assigned by supervisors.
• Maintain and organize personal reference materials to ensure quick access to financial and clinical information.
• Participate in quality improvement initiatives as needed

Preferred Experience

• Minimum of 1-2 years of office or clerical experience, preferably in a healthcare setting.
• Strong computer literacy and familiarity with healthcare software systems.
• Prior experience in a call center environment is preferred.
• Knowledge of healthcare payer regulatory compliance and the hospital revenue cycle.
• Ability to perform general arithmetic and interpret data with attention to detail and accuracy.
• Excellent verbal communication skills with the ability to interact in a respectful and compassionate manner with patients, families, and colleagues

Required Licensure/Education

• High School Diploma or equivalent required.

Preferred Education

• Completion of medical terminology coursework preferred.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our Commitment to You:

Riverside Healthcare offers a comprehensive suite of Total Rewards: benefits and nationally rated employee well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more so your journey at and away from work is remarkable. Our Total Rewards package includes: 

Compensation

•              Base compensation within the positions pay range based on factors such as qualifications, skills, relevant experience, and/or training
•              Premium pay such as shift differential, on-call
•              Opportunity for annual increases based on performance

Benefits - .5 to 1.0 FTE

•              Paid Time Off programs
•              Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
•              Health Savings and Flexible Spending Accounts for eligible health care and dependent care expenses
•              Defined contribution retirement plans with employer match and other financial wellness programs
•              Educational Assistance Program

Benefits - .001 to .49 FTE:

•              Paid Leave Hours accrued as you work

Employee Health Requirements

Exposure to:

• Chemicals: None
• Video Display Terminals: Average
• Blood and Body Fluids: Performing ER and Admitting registrations have the potential to be exposed.
• TB or Airborne Pathogens: Performing ER and Admitting registrations have the potential to be exposed.

Sensory requirements (speech, vision, smell, hearing, touch):

• Speech: Required to communicate during presentations/training, telephone communication, and facilitate meetings. 
• Vision: Needed to read memos and literature, close vision (ability to adjust focus).
• Smell: NA
• Hearing: Needed for telephone communication, meetings, alarms and listening to employee and patients.
• Touch: Needed to write, computer entry, filing.

Activity/Lifting Requirements:

Percentage of time during the normal workday the employee is required to:

• Sit: 50-88%
• Twist: 5%
• Stand: 1%
• Crawl: 0%
• Walk: 12-50%
• Kneel: 0%
• Lift: 0%
• Drive: 0%
• Squat: 0%
• Climb: 0%
• Bend: 5%
• Reach above shoulders: 2%

The weight required to be lifted each normal workday according to the continuum described below:

• Up to 10 lbs: Frequently
• Up to 20 lbs: Frequently 
• Up to 35 lbs: Occasionally 
• Up to 50 lbs: Occasionally 
• Up to 75 lbs: Not Required
• Up to 100 lbs: Not Required 
• Over 100 lbs: Not Required

Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.): Carrying materials such as charts and labels waist high and for approximately 20 feet.

Maximum consecutive time (minutes) during the normal workday for each activity:

• Sit: 30
• Twist: 1
• Stand: 5
• Crawl: 0
• Walk: 5
• Kneel: 0
• Lift: 0
• Drive: 0
• Squat: 0
• Climb: 0
• Bend: 0
• Reach above shoulders: 1

Repetitive use of hands (Frequency indicated):

• Simple grasp up to 10 lbs. Normal weight: 5- 10lbs frequent
• Pushing &pulling Normal weight: <50lbs>
• Fine Manipulation: Computer keyboard, writing, calculator.

Repetitive use of foot or feet in operating machine control: Not Required

Environmental Factors & Special Hazards:

Environmental Factors (Time Spent):

• Inside hours: 8 
• Outside hours : 0
• Temperature: Normal Range 
• Lighting: Average
• Noise levels: Average 
• Humidity: Normal Range 
• Atmosphere:

Special Hazards: Explosive-O2 hook-ups in department

Protective Clothing Required: None