Pre-Access Specialist

Overview:

Responsibilities:

• Obtains daily work through systems’ work queues and reports as assigned by supervisor.
• Completes eligibility check and obtain benefits though electronic means or via phone contact with insurance carriers or other agencies.
• Contacts patients/families/physicians to obtain additional demographic/insurance information and update in computer system if needed in order to proceed with verification process.
• Demonstrates subject matter expertise with insurance requirements across multiple affiliates.
• Accurately and thoroughly collects, analyzes and records demographic, insurance/financial and clinical data in computer system. Ensures information source is appropriate.
• Explain benefits and request copay, coinsurance and portion of deductible.
• Follows department policy for payment or nonpayment responses.
• Requests patient to bring required documents on day of service, i.e., physician orders, insurance cards, claim forms, liability information, photo ID, etc.
• Documents in system the need for front-end Patient Access Associate to collect at time of service any copay or deductible that could not be collected during the preregistration process.
• Identifies patients in financial hardship and refer to Patient Financial Coordinators for charity/financial assistance.
• Refers to Cash Posting Specialists any patients requiring payment plans.
• Completes registration checklist.
• Documents on accounts using hospital account note with activity comments to ensure easy account follow up.
• Follows EMTALA, HIPAA, payer and other regulations and standards.
• Other duties as assigned

• Adheres to department customer service standards.
• Demonstrate the FOCUS values to provide the best customer services to patients, customers, vendors, and team members.
• Acts willing and ready to assist department personnel with their duties as time permits or need arises.
• Readily identifies work that needs to be performed and completes it without needing to be told

Qualifications:

• Requires minimally a High school diploma or GED.
• Two years of experience in a hospital patient access/patient accounts department, medical office/clinic or insurance company is desired/preferred.

• Previous customer service experience.
• Experience interacting with patients and a working knowledge of third party payers and collections is preferred.
• Prior experience with verification, and payer benefit and eligibility systems is preferred.

• Ability to perform a variety of tasks, often changing assignments on short notice.
• Must be adept at multi-tasking
• Will be required to learn and work with multiple software/hardware products (sometimes concurrently) during an average workday
• Must possess excellent communication skills, verbal and listening.
• Must be able to maintain a professional demeanor in stressful situations.
• Adept with technology typically found in a business office environment.
• Mathematical aptitude to make contractual calculations and estimate patient financial obligations.
• Able to build productive relationships with all contacts.
• Must be able to perform data entry with speed and accuracy
• Knowledge of Medical Terminology is preferred.