Patient Access Specialist

Position Summary

This position is responsible for reviewing, verifying, and filling in missing registration/insurance information on encounters received electronically. The role applies and/or corrects billing details based on insurance carrier requirements and established departmental and company policies and procedures.

Essential Duties and Responsibilities

• Manages multiple client accounts according to assigned volume and established productivity expectations.
• Routinely monitors and reports low volumes, missing dates of service, and encounters lacking required insurance or payer information.
• Uses the RICA coding application and AthenaIDX to update and correct demographic records based on hospital/client data, resolving demographic, insurance, and Patient Access–related errors, edits, and rejections.
• Conducts necessary verification checks and assigns accurate payer information to support timely billing and maintaining a minimum accuracy rate of 95% in accordance with departmental and company policies.
• Takes ownership of Level 2 escalations from the offshore team, identifies and resolves issues preventing claim submission, and provides feedback or trending observations to the PA & EDI Supervisor for follow-up.
• Processes work within 2 business days from the date the work became available; notifies supervisor when not on target.
• Completes daily production records accurately and on time.
• Communicates any deviations from established workflows and escalates issues that impact daily submission or month-end close.
• Consistently communicates with others with respect, kindness, and understanding; is honest and clear; treats sensitive information confidentially; is perceived as positive and demonstrates quality services. 
• Collaborates with internal teams (Billing, Coding, Enrollment, EDI, Leadership) when clarification or cross-departmental support is required.
• Participates in ongoing training, updates, and process improvements, ensuring compliance with evolving payer guidelines and internal workflows.
• Performs other related duties as assigned.
• Adheres to all Company policies and procedures (i.e. Administrative and Human Resources), practices safe work habits, and maintains high business standards.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. 

Knowledge, Skills, & Abilities

• Strong attention to detail and accuracy, with the ability to identify discrepancies in demographic and insurance information.
• Ability to interpret eligibility files and understand payer requirements, rules, and coverage limitations.
• Knowledge of insurance types, payer hierarchy, and coordination of benefits.
• Ability to work independently with minimal supervision, manage pressure, and meet established deadlines.
• Computer literacy and proficiency with Microsoft Office (Excel required)
• Excellent communication skills for collaboration with internal teams and external partners
• Ability to prioritize work and manage competing tasks
• Understanding of HIPAA and handling of Protected Health Information (PHI)
• Critical thinking and problem-solving abilities to identify root causes of errors and determine appropriate corrective actions.

Education & Experience Requirements

• Requires High School Graduate or GED. 
• Minimum of one year in the healthcare industry.
• Experience with Athena IDX a plus.
• Preferred Insurance data entry / Medical Front office training and/or Certification.

Supervisory Responsibilities

No Supervisory Responsibilities