PATIENT ACCESS SPECIALIST 1
Company: Mercy Health System
Location: Janesville
Posted on: September 29, 2024
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Job Description:
Overview
Job Profile Summary
Responsible for correctly prioritizing and completing all steps of
the scheduling, referral management, authorization, verification
and registration process prior to patients receiving services.
Identifies scheduling needs, reviews schedules, follows scheduling
protocols and enters visit information for appropriate scheduling.
Identifies, verifies, and captures appropriate patient demographic
information and health insurance benefit eligibility information.
Performs payer coverage investigation, as necessary, utilizing both
internal and external tools and resources, to obtain reimbursement
verification. Utilizes knowledge including, but not limited to,
managed care, commercial, government, and work comp insurance
billing requirements, as well as current coding guidelines and
standards, to ensure resolution of pre-service edits, appropriate
management of claims, initiation and direction of accounts for
pre-authorization as required, prevention of timely filing claim
denials, and procurement of appropriate reimbursement. This
position requires understanding of healthcare Revenue Cycle and the
importance of evaluating and securing all appropriate financial
resources to maximize reimbursement to the health system. This
position assumes clinical and financial risk of the organization
when collecting and documenting information on behalf of the
patient.
Responsibilities
Ensures all scheduled visits are pre-registered and accounts are
appropriately certified / authorized in advance of the service
date.
Initiates, obtains, and documents
referrals/authorizations/pre-certifications in appropriate
systems.
Answers incoming external/internal telephone calls, determines
purpose of calls and schedules appropriately or routes to physician
practices or other departments as appropriate.
Registers new and returning patients via multiline phone lines, and
various Mercy systems/applications for visits within the
Mercyhealth System ensuring that all required elements are gathered
to ensure payment for the service provided.
Initiates outbound calls to external providers, patients, and/or
payers based on referrals entered into the system and schedules
appropriately. Communicates with provider's office as needed.
Ensures compliance with Access and Revenue Cycle related policies
and procedures.
Manages waitlists, rescheduling/cancellation of appointments as
necessary.
Completes accounts in assigned WQ's.
Manages patient initiated scheduling requests through MyChart,
Telehealth, or other self-scheduling applications.
Maintains a high level of professionalism and provides a quality
patient experience.
Schedules appointments appropriately according to provider and
clinic based protocols.
Performs ancillary tasks by providing outreach to patients. Must
have excellent customer service skills.
Answers questions about organization and provides callers with
address, directions and other information about the site that they
are scheduled for.
Able to articulate information in a manner that patients,
guarantors, and family members understand.
Ensures compliance with reporting related to demographics and
federal and state requirements.
Has in depth knowledge of community based, state or federal
government programs to provide assistance to patients who have
limited or no ability to pay for their health care needs. Screens
patients and provides assistance with completion of applications,
if necessary.
Serves as a liaison to clinical staff by maintaining good
communication regarding any problems and/or resolutions to patient
issues or access concerns. Contacts insurance companies or employer
groups via phone, web portals, electronic applications, or other
appropriate means to determine eligibility and benefits for
necessary services to obtain financial resolution and guarantee
payment on account.
Maintains current knowledge of payor payment provisions and
regulations to ensure correct data is gathered and documented.
Provides financial information to patients, which includes patient
financial obligations, estimated costs of services, billing
practices and establishing payment arrangements as necessary.
Collects co-pays, deductible and other out of pocket expenses via
phone and/or in person and ensures patients understand their
financial obligation and arrange for payment at the time of
visit.
Must have a thorough understanding of patient payment options to be
able to direct patients to appropriate resource for financial
assistance programs. These programs may include Medicaid, Mercy
Community Care and other community assistance as appropriate.
Advises department leadership of possible postponement or deferral
of any elective/non-emergent service which have not been approved
prior to service date.
Documents activity within appropriate EMR or patient accounting
systems.
Complies with Mercyhealth Cash Handling and Collection
Policies.
Demonstrates an understanding and follows patient confidentiality
policies and all HIPAA Regulations.
Performs other clerical duties as needed such as faxing, filing and
photocopying.
Subject matter expert with regards to assigned
responsibilities.
Provides training to new partners, as well as on an as-needed
basis.
Manages other duties as assigned.
Completes pre-registration and ensures appropriate referrals are in
place and authorized.
Ensures compliance with Access and Revenue Cycle related policies
and procedures.
Reviews external orders/referrals to ensure authorization and
compliance requirements are met.
Assist with schedule utilization reports/documentation
Participates in workgroups related to access/scheduling
improvements.
Notifies leadership of scheduling or access issues (time to next
appt, provider cancellations, etc)
OPAM schedules for all specialties and modalities across the
system.
OPAM Pre-Registration process is a different. As they are
scheduling the patients and have them on the phone, they are
reviewing their personal information and also checking on their
insurance, is it in network, and additional verification. Triaging
it a bit further as an example IF it is a worker's compensation and
then follow additional information.
Promoting digital access and patient engagement to get them to
leverage the capabilities that exist. (example: EPIC)
OPAM looks at the patient holistically, including current visit
needs and then understanding additional needs of the patient and
schedule them with another department.
Broader view of schedules to ensure coordination occurs throughout
the whole system rather than at one physical location.
Ensure that Medical necessity is met.
Utilization of waitlists for the system to ensure that we are
accelerating patients accessing system.
Focuses on schedule optimization by different area bringing in
consistencies to services from a system perspective.
Looking for throughput optimizations as they work with different
areas to maximize scheduling efficiencies across the system.
Needs the ability to understand multiple specialties and modalities
and have the ability to support all of them.
Keywords: Mercy Health System, Janesville , PATIENT ACCESS SPECIALIST 1, Other , Janesville, Wisconsin
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