Patient Access Coordinator

Here, it's different. Come join us.

Children's Hospital Colorado has defined and delivered pediatric healthcare excellence for more than 100 years.

Here, the nation's brightest nurses, physicians, scientists, researchers, therapists, and care providers are creating the future of child health. With an optimist's outlook, a trailblazing spirit, and a celebrated history, we're making new strides every day.

We've been Magnet-designated four times by the American Nurses Credentialing Center and are consistently recognized among the best of the best pediatric hospitals with #1 rankings in Colorado and the region by U.S. News & World Report.

As a national leader in pediatric care, we serve children and families from all over the nation. Our System of Care includes four pediatric hospitals, 11 specialty care centers, 1,300+ outreach clinics and more than 10,000 healthcare professionals representing the full spectrum of pediatric care specialties.

Here, we know it takes all of us, every role, to deliver the best possible care to each child and family we treat.

That's why we build our teams toward a foundation of equity in access, advancement, and opportunity. We know teams of individuals with different identities and backgrounds can nurture creativity and innovation. We know we can see, treat, and heal children better when our team reflects the diversity of our patient population. We strive to attract and retain diverse talent because we know a truly inclusive and equitable workforce will help us one day realize our most basic calling: to heal every child who comes through our doors.

A career at Children's Colorado will challenge you, inspire you, and motivate you to make a difference in the life of a child. Here, it's different.

The Patient Access Coordinator works in close coordination with Patient Access leadership and other clinical and operational stakeholders to complete assigned tasks including denial management, financial clearance of complex visit types, and resolution of escalated high-risk issues. Supports performance improvement efforts by conducting root-cause analysis of data (including denial and patient data), summarizing analyses of identified trends, and supporting meetings with operational stakeholders to drive issue resolution. This position is a liaison between Primary Care Physicians (PCPs), patients, internal providers, Managed Care, and other revenue cycle team members to support Patient Accesses needs and goals. Responsible for working with Patient Access and other departments to develop and maintain training and guidelines around specific patient areas such as: RAVE (Referrals, Authorization, Verification and Eligibility), Financial Counseling, Scheduling, Registration, Admissions, Referrals, Check-in, or Patient Family Access Center. This position requires strong partnering with management and staff across multiple areas but is not limited to Patient Access, Ambulatory Services, Case Management, Patient Financial Services and HIM.

Department Name: Insurance Verification
Job Status: Full time, 40 hours per week.
Shift: Day shift, Hybrid

• Education: High School Diploma or equivalent required.
• Experience: Four (4) years of experience in revenue cycle, claim mitigation and account research, or patient access.
• Equivalency: A relevant associate or bachelor's degree may substitute for the required experience on a year for year basis.

POPULATION SPECIFIC CARE

No direct patient care.

ESSENTIAL FUNCTIONS

An employee in this position may be called upon to do any or all of the following essential functions. These examples do not include all of the functions which the employee may be expected to perform.

• Participates in Patient Access projects, conducting in-depth research and proposing solutions for root cause issues impacting patient accounts, insurance verification, and authorizations. Independently works through complex issues with key stakeholders.
• Coaches and assists team members with challenging accounts. Supports supervisor with ad hoc tasks like analysis, training, and meeting prep.
• Partners with key stakeholders to address patient populations and trends, ensuring follow-up on action items from meetings.
• Identifies high-level trends through data analysis, conducts specialized account research to understand root causes, and proposes/implements solutions. Identifies and implements workflow improvements in Patient Access and other departments.
• Leads recurring meetings discussing metric trends, presents research findings, and proposes actionable solutions with relevant departments. Tracks progress on solutions to ensure prevention measures.
• Resolves assigned accounts (denials, appeals, retro-authorizations) by gathering information, researching contract terms, and ensuring timely appeal submissions. Collaborates with departments and stakeholders to obtain necessary support.
• Develops and delivers training materials for denial management best practices, supporting teams in effective denial management. Works with Patient Access Training team and management to develop documentation and guidelines for denial management.
• Assists users with denial management software, updates and maintains trending reports, and analyzes metrics to identify impactful denial trends.
• Works with systems to identify payment, billing, and collection issues, communicating them to relevant departments within Patient Access and others.
• Ensures adherence to all relevant healthcare compliance and regulatory requirements in daily tasks and projects.
• Maintains high performance standards, actively participate in self-development opportunities, and contributes to team and department goals.

SCOPE & LEVEL

Guidelines: Fully qualified, full performance or journey level. Guidelines are generally but not always clearly applicable, requiring the employee to exercise judgment in selecting the most pertinent guideline, interpret precedents, adapt standard practices to differing situations, and recommend alternative actions in situations without precedent.

Complexity: Duties assigned are generally complex and may be of substantial intricacy. Work assignment is performed within an established framework under general instructions but requires simultaneous coordination of assigned functions or projects in various stages of completion.

Decision Making: Exercises judgment and discretion, and is responsible for determining the time, place and sequence of the work performed.

Communications: Contacts with team members, clients, or the public where explanatory or interpretive information is exchanged, defended, and gathered and discretion and judgment are required within the parameters of the job function.

Supervision Received: Performs work with minimal supervisory oversight. Under general supervision, the employee receives assignments and is expected to carry them through to completion with substantial independence. Work is reviewed for adherence to instructions, accuracy, completeness, and conformance to standard practice or precedent. Recurring work clearly covered by guidelines may or may not be reviewed.

Ability to Perform Essential Functions of the Job

It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. Be aware that none of the questions are intended to imply illegal preferences or discrimination based on non-job-related information.

The position is expected to stay open until the posted close date. Please submit your application as soon as possible as the posting is subject to close at any time once a sufficient pool of qualified applicants is obtained.

Here, you matter. As a Children's Hospital Colorado team member, you will receive a competitive pay and benefits package designed to take care of your needs that includes base pay, incentives, paid time off, medical/dental/vision insurance, company provided life and disability insurance, paid parental leave, 403b employer match (retirement savings), a robust wellness program, and access to professional development tools, including an education benefit to help you advance your career.

As part of our Total Rewards package, Children's Colorado offers an annual employee bonus program that rewards eligible team members based on organizational performance. If organizational goals are met for the year, the bonus is paid out the following April.

Children's Colorado delivers annual base pay increases to eligible team members based on their performance over the previous year.