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Patient Access Specialist in Marinette, WI at Bay Area Medical Center

Date Posted: 8/7/2018

Job Snapshot

Job Description

Location:  Bay Area Medical Center
Requisition Number:  2272
# of Openings:  1
Title:  Patient Access Specialist
Department:  8040 - Patient Access
Position Type:  AFSCME – Full time
Shift:  1 – Days
Hours:  Variavle between 7am-5:30 pm
FTE:  1.0 FTE
40 hr. waiver required:  No
Is call required:  No
Weekend Rotation:  Occasional
Removed Internally:  8/4/18

TITLE:                       Patient Access Specialist

Department:            Patient Access
Reports to:              Patient Access Manager
Supervises:             N/A

Job Summary:
Responsible for scheduling, pre-registrations, and authorizations for all BAMC guests and conducting pre-service guest contacts.  This position is responsible for verifying medical necessity for all tests and procedures, physician follow up relating to medical necessity and insurance eligibility determinations. Responsible for scheduling various exams for multiple departments via the computer.  Position coordinates schedules to ensure proper sequencing of exams by department. 
Essential Functions:
  • Understand and live BAMC’s mission and values.
  • Accurately collect and analyze all required demographic, insurance/financial, and clinical data elements necessary to schedule all types of patients by interviewing physicians and their office personnel, other referring providers, the patient and/or appropriate patient representative(s); receiving information via facsimile transmission, mail, previously recorded information, and all other available documents and forms such as insurance cards, etc.; and records and electronically enters the information on a timely basis.
  • Assumes the responsibility for coordinating all exams with ancillary units
  • Complete insurance eligibility and benefit verification for all available payers using electronic transactions when available and telephone contacts when required. 
  • Maintains an employer/insurance matrix with payer and benefit information.
  • Complete managed care screening for each account; maintain the authorization log by coordinating all authorizations for BAMC guests; and when needed communicate insurance information to ancillary staff.
  • Use compliance software to evaluate outpatient order and diagnosis against medical necessity regulations and payer requirements to determine coverage; notify physician office when information is lacking or the procedure does not meet medical necessity requirements; and communicate information to guest
  • Conduct pre-service guest contact to validate data set information; create pre-registration record; provide clinical orientation, financial education and negotiation; and resolve pre-service edits.
  • Accurately prepares, produces, and distributes to other internal and external parties as appropriate and on a timely basis, required forms, reports, items and documents.
  • Act as a liaison between patients, families, and BAMC.
  • Must maintain guest confidently at all times.
  • Participates in performance appraisals by identifying goals by reviewing progress with manager.
  • Projects a mature, compassionate, concierge-style customer service attitude and professional demeanor while dealing with patients and all parties encountered.
  • Works effectively and with flexibility in high-stress and fast-paced situations.
  • Understands all expected job outcomes and displays personal accountability at all times in order to meet all commitments.
  • Displays an attention to detail and accuracy, and achieves outcomes consistent with the specific job requirements.
  • Displays a positive attitude to required changes and contributes effectively to the change process.
  • Participates in orientation and training.
  • Fully knowledgeable of the comprehensive revenue cycle policies and procedural flow, and able to apply this knowledge to all situations.
  • Works diligently and aggressively at all times including seeking other assignments as time permits.
  • Participates as an effective team member and promotes collaboration and team spirit at all times to maximize group effectiveness, including offering assistance and encouragement to others.
  • Possesses and applies knowledge of how to operate routine office equipment including such devices as facsimile machines, copiers, plate production machines, online credit authorization devices, optical scanning equipment, etc.
  • Demonstrates knowledge for scheduling multiple exams, ensuring the protocols are compatible.
  • Possesses the ability to appropriately prioritize and perform multiple tasks at one time, as well as modifying plans and approaches based on changing situations and needs, and follows-through to achieve final resolution.
  • Willingly accepts additional duties as necessary to meet the customers’, department’s and hospital’s needs.
  • Maintains and applies specific knowledge of payer UB-04 edit information in order to understand and resolve flagged edit failures.
  • Possesses and applies intermediate math skills necessary to calculate anticipate charges for services, the anticipated third party and patient liabilities, financial asset and program qualification, etc.
  • Must be able to complete the physical, sensory and mental requirements of the position.
  • Additional duties as may be assigned by your supervisor or director.
High school graduate or equivalent.  Two years direct customer service and pre-authorization or scheduling experience required.   Medical terminology course completed with a C or better required. Credentialed Revenue Cycle Representative Certification (CRCR) required. 
Ability to read and interpret physician orders and clinical information, including a basic understanding of procedure and diagnosis coding conventions required, coding certification preferred.  Ability to perform insurance and patient liability calculations.  Competency in regulatory compliance areas.  Must have working knowledge of computers and ability to type 35 wpm required.  Accuracy, dependability, confidentiality and the ability to work well in a team environment are essential.  Successful candidate must be highly organized and able to make independent decisions.  Successful candidate will possess strong interpersonal skills and the emotional intelligence required to completed sophisticated communication and negotiation with patients and employees.
Working Conditions:
Requires sitting and occasional walking.  Work is mental rather than physical. Stressful position due to workload volume and responsibility.  Potential exposure to Latex products, blood borne pathogens, hazardous materials, and communicable diseases.