Patient Access Specialist

Job Description

Patient Access Specialist

Position Summary:

The primary role of this position is to serve as liaison between the provider practices and patients in the process of scheduling, obtaining prior authorization for testing, diagnostic imaging, and referrals to other providers. The goal of the Patient Access team is to assure that these processes are managed effectively and efficiently in order to provide seamless and convenient access to specialized services deemed necessary by the patient and their provider to improve health outcomes and utilization of available services within the healthcare delivery system.

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Responsibilities and Expectations:

• Responsible for total coordination and processing of all patient referrals for diagnostic testing and specialty services.
• Verifies insurance eligibility and benefits and updates the patient’s insurance information as necessary.
• Identifies the referral and authorization requirements of the patients’ insurance plans by using various on-line resources according to department workflows.
• Demonstrates the ability to request, prepare, and recognize the documentation required to support the medical necessity for the service being authorized.
• Enters all referral authorizations into the computer system. Maintain tracking of referral reports not received and timely follow-up in accordance with the office policy and procedures.
• Maintain tracking of patients referred but not following through with a referral appointment and documenting patient response or lack of.
• Reviews details and expectations about the referral appointment with the patients.
• Completes referrals and prior authorizations in a timely manner according to department guidelines and workflows.
• Communicates clearly and effectively with patients, physicians, office staff and manager to resolve issues that may result in a denied or delayed authorization request.
• Schedule patient as per provider referral order for diagnostic testing, therapy or specialist appointment at network facilities or specialty office.
• For specialist referrals, assemble pertinent office notes, labs, testing, etc. and fax to specialist office and give patient referral letter with specialist name, location with directions if necessary, date and time of appointment.
• For diagnostic testing patient will be advised of date, time and necessary test preparations. Check chart for test orders and make sure it has been faxed to the appropriate facility. If order is not present in chart, send note to provider to order the test in the chart and fax to appropriate facility.
• A patient note containing referral information is sent to the primary referral coordinator for necessary insurance pre-authorizations and saved to chart when process is completed.
• Demonstrates complete system knowledge, ability to run reports, document and manage referrals and authorizations, move correspondence, resolve eligibility and authorization holds, and other system tasks within the user’s security access.
• Demonstrates the ability to use the electronic tools and systems available to organize and process the daily work.
• Provides the supervisor and manager with immediate feedback on issues affecting workflow, reimbursement, and customer service.
• Ensures that appropriate and accurate information is entered in the patient account.
• Responds timely and collaborates effectively with the Reimbursement Department teams to limit denials and ensure proper reimbursement.
• Exhibit excepted level of teamwork and respect. Collaborates with team members to meet department deadlines and benchmarks.
• Anticipates and performs necessary job duties.
• Maintains patient confidentiality
• All special projects work, additional tasks, or other duties as assigned
• Follow all Policies and Procedures
• Meet/Exceed established quality and productivity expectations
• Maintain attendance according to departmental standards
• Complete safety evaluation, JCAHO education, Confidentiality, Information system usage, HIPAA corporate compliance education on an annual basis.

Job Requirements

• Minimum of one (1) years of physician office experience.
• Knowledge of medical terminology
• Knowledge of ICD-10 and CPT codes for the purpose of authorizations
• Knowledge of insurance plans and their rules

Skills

• Excellent customer service skills
• Effective verbal, written and listening communication skills
• Ability to work independently, self-motivated, and prioritize.
• Ability to establish and maintain effective working relationships with patients, medical staff, and co-workers
• Ability to work with a diverse patient, physician and coworker population
• Proficient computer skills – data entry, retrieval and report generation.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, identity, family status, gender, disability, or veteran status.

WORKING CONDITIONS:

8:00am – 5:00pm M-F or hours as required by the job.

May require occasional paid overtime.

Expected to adhere to office policy and procedures.

Subject to blood and body fluid exposure.

Subject to frequent interruptions and changes in priority of duties throughout the day.

Sitting/standing/moving about during working hours.

Spends time during the day using computers, telephones and printers.

PHYSICAL REQUIREMENTS ADDENDUM

PURPOSE: To identify specific functions job requirements and work environment factors that could affect job performance.

Check all factors that are present as essential job requirements and check whether the factor is performed.

O = Occasionally = 0- 33% of the work shift or 0- 32 repetitions.

F = Frequently = 34-66% of the work shift or 32-200+ repetitions.

C = Constantly = 67-100% of the work shift or 200+ repetitions.

N = Not essential job requirement.

C Standing

C Walking

O Lifting (70 pounds)

O Carrying (70 pounds)

O Pushing (70 pounds)

N Climbing with (70 pounds)

O Stooping/Bending

O Twisting/Turning

O Kneeling/Squatting

O Crawling

O Reaching Up/Reaching Forward

Additional information concerning physical requirements for the position:

Please list any additional requirements

Responsible to:

Patient Access Coordinator

Director of Business Operations