Patient Access Insurance Specialist
Req ID: 8493
The Patient Access Insurance Specialist (PAIS) position is a part of the Financial Clearance Center (FCC), the starting gate for the patient hospital experience. PAISs are members of a strong team in a dynamic, client focused, fast paced department. The primary focus for this role is to mitigate the financial risks to our hospital clients. To do this this position is responsible for contacting patients directly and/or using alternative means to secure patient’s information such as demographics, insurance/coverage and clinical information needed to determine patient’s eligibility, coverage, and insurance limitations. Patient Access Insurance Specialist will use analytical skills to make decisions and explain coverage details so that patients completely understand what their financial responsibility will be. Associates in this role are empowered to identify additional resources and refer patients who might have difficulty meeting their financial responsibilities. Success in this role is measured with the use of weekly productivity scorecards. Hard work, exemplary performance and continuously expanding knowledge base can lead to opportunities to move up and become a great people leader at R1.
Reports directly to a department Operations Supervisor and receives daily ongoing support from the PAIS Team Lead.
Your day to day role will include:
- Initiates contact with client hospital patients via telephone using appropriate scripting to ensure the required level of benefit and pre-certification/authorization details such as demographics, insurance/ coverage and clinical information are obtained.
- Complete appropriate electronic forms with detailed benefit and pre-certification/ authorization information to ensure a clean claim.
- Identifies inaccurate plan codes and corrects in the hospital’s main frame.
- Work directly with multiple insurance websites to obtain benefits and authorization validation.
- Adheres to the guidelines set forth in the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI).
- High School diploma or equivalent.
- At least one (1) year of similar experience (patient-facing, patient access).
- Excellent customer service skills exhibiting good oral and written communication skills.
- Ability to type fast and accurately.
- Must be able to communicate effectively and professionally to our patients and physician offices.
It would be great if you also have:
- Basic Word/Excel
- Medical Terminology
- Coding/Billing experience
R1 is changing healthcare by infusing operational discipline and proprietary technology in hospital financial processes. We are an industry leader; we are the only independent organization with a comprehensive service and technology offering for hospital revenue cycle management, and we have achieved leading outcomes for our customers.
- A strong financial performing, growing organization that will keep you on your toes with new ideas, changes and opportunities to learn and grow in abundance.
- A culture of excellence, driving customer success so they can focus on improving patient care and on giving back to the community.
- A Total Rewards package which may include such things as: competitive compensation package, the ability to choose from a comprehensive benefit program mostly funded by R1 that includes medical, dental, vision, flexible spending accounts, commuter benefits, life and disability insurance, along with work life balance programs including paid time off for personal time, illness and volunteering, and we offer a retirement savings plan and continuing training and development and so much more!
Sound like you? Let’s talk!
R1 is a leading provider of revenue cycle management services and Physician Advisory Services to healthcare providers. We are the largest independent end-to-end revenue cycle provider and have the longest operating history in the revenue cycle industry. R1’s objective is to be the one trusted partner to manage revenue so providers and patients can focus on what matters most. Our distinctive operating model and values includes people, processes, and sophisticated integrated technology/analytics that help customers realize sustainable improvements in their operating margins and improve the satisfaction of their patients, physicians, and staff. We are dedicated to transforming the commercial infrastructure and patient experience in healthcare.