Contract Utilization Review Jobs in Springfield, IL

The Patient Access Specialist is responsible for coordinating patient entry into hospital and affiliated healthcare services. The position ensures accurate and efficient patient registration while supporting financial, compliance, and customer service functions.

Key Responsibilities

• Accurately process patient registration and admission information
• Collect and verify patient demographic details and insurance (third-party payer) information
• Perform financial collections and explain payment responsibilities
• Present and explain required legal, ethical, and compliance documents during registration
• Maintain confidentiality and compliance with healthcare regulations
• Schedule services such as mammography screenings
• Serve as a liaison between ancillary departments and Patient Access Services teams
• Provide service in patient care environments while maintaining professionalism and compassion

Knowledge & Compliance Requirements

• JCAHO standards
• Patient Rights and Responsibilities
• HIPAA privacy regulations
• HMOs and commercial insurance payers
• Departmental policies and procedures

Work Schedule

• Shift: Day
• Hours: 1:00 PM - 5:00 PM
• Weekends: Rotation as Specified by Department 
• FTE: 0.5 (Part-Time)

To review Memorial's Benefits click here: Benefits - Memorial HR

• High School Diploma required.

• Must successfully complete assigned annual education through Healthcare Business Insights.

• Minimum of one (1) year of business office experience preferred, including:
  • Patient Access
  • Billing and collections
  • Insurance principles and practices
  • Accounts receivable
• Completion of twelve (12) hours of coursework in a business or healthcare-related field may substitute for business office experience.
• Previous Patient Access experience strongly preferred.

• Comprehensive understanding of Patient Access Service functions to support accurate registration and reimbursement processes.
• Strong interpersonal and patient relations skills with demonstrated professionalism, tact, and sensitivity when interacting with patients, families, staff, and the public.
• Ability to maintain emotional composure and professionalism in fast-paced or high-stress environments.
• Proficient computer skills including data entry, electronic documentation, and use of registration software and healthcare systems.
• Excellent attention to detail with strong critical thinking and problem-solving abilities.
• Effective oral and written communication skills with exceptional customer service focus.
• Demonstrated flexibility, sound judgment, and initiative when managing competing priorities.
• Ability to work independently while contributing positively to team and organizational goals.
• Skilled in patient education, persuasion, and negotiation related to financial and registration processes.
• Knowledge of medical terminology, CPT procedural coding, ICD-10-CM diagnosis coding, and hospital billing claims preferred but not required.

• Completes all steps of pre-registration and registration; verifies patient identity and demographic information through appropriate tools.
• Identifies and 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 and effectively according to established protocol, including modality, location, facility capabilities, insurance requirements, type of exam, patient preferences, and urgency.

• Educates patients and others regarding resolution of billing issues, 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 and an interdisciplinary approach to patient and organizational needs.
• Negotiates with patients and families to collect co-pays and/or deposits at point of service and supports Patient Access Services (POS) collection goals as defined by Revenue Cycle leadership and best practice benchmarks.

• Adheres to CMS Conditions of Participation regulations and Section 1154(e) of the Social Security Act regarding delivery, explanation, and acquisition of patient or representative signatures.
• Verifies medical necessity and obtains appropriate signature on Advance Beneficiary Notice of Non-Coverage (ABN) per CMS regulations at point of patient access.
• Ensures compliance with HIPAA, Joint Commission, CDC, SMH, and all applicable state and federal statutes, providing required literature at all Patient Access Service access points.
• Educates patients regarding Advance Directives, Medicare Part D prescription coverage, SMH, Joint Commission, and Illinois Department of Public Health grievance processes as appropriate.
• Maintains current knowledge of and compliance with the Illinois Fair Patient Billing Act and Illinois Uninsured Patient Discount Act.

• Triages, documents, and initiates referrals to Medicaid vendors and/or financial assistance programs per applicable Illinois laws and SMH procedures.
• Identifies and reviews services requiring pre-authorization or pre-certification by Medicare, Medicaid, Commercial, and Managed Care payers to ensure eligibility requirements are met prior to service; communicates with physician offices and uses appropriate technology.
• Analyzes rejected account reports from hospital sources, including Non-Patient Access registration departments, to resolve eligibility issues, secure reimbursement, or determine financial assistance eligibility.

• Orients and cross-trains others within assigned area of responsibility as directed by management.
• Assists other areas within the unit or department during times of special need or staffing shortages.
• May be required to work night or weekend shifts.
• May rotate work settings, including patient registration, bedside registration, and other SMH campus environments.
• May provide coverage for the SMH Financial Lobby Office.
• Develops and maintains comprehensive knowledge of the health system organization and completes all assigned annual organizational education.
• Meets expectations for productivity, accuracy, and point-of-service collections.
• Attends quarterly department meetings unless absence is approved by management in advance.
• Performs pre-registration functions as requested.
• Performs other related duties as required or assigned.