Pre-Access Specialist, First - University

Overview:

The Pre-Access Specialist will be responsible for verifying accurate insurance and demographic information, obtaining or verifying authorization, referrals or precertification, checking medical necessity, creating patient estimates and having financial clearance conversations with patients for outpatient procedures.

The Pre-Access Specialist will coordinate patient orders received from physician offices and internal ancillary departments assuring appropriate distribution to the servicing department. Reviews 100% of all scheduled procedure orders for accuracy including physician signature, test/procedure to be performed, date and diagnosis, calls physician office to clarify order as needed, and indexes order to the account.

Coordinates patient encounter utilizing multiple system applications: various registration applications, clinical operating systems, eligibility verification systems, medical necessity applications, scanning repository.

Responsibilities:

• Contacts insurance plans/payers to determine eligibility and obtain coverage and benefit information.
• Contacts payers and physician offices to obtain prior authorization for services.
• Documents findings thoroughly and accurately.
• Meets or exceeds productivity standards in the completion of daily assignments and accurate production.
• Makes changes to demographic information as necessary in order to produce a clean patient statement.
• Creates patient estimates and conduct financial clearance conversations with patients.
• Answer and respond to external and internal phone calls in a timely manner. Check and respond to emails in a timely and professional manner.
• Manages all orders received by fax, physician EMR or other sources and scans into appropriate hospital electronic patient medical record.
• Index orders accurately and review physician signature, test/procedure to be performed, date and diagnosis for accuracy.
• Complies with all department and hospital policies and procedures.
• Complies with local, state, and federal rules and regulations, and the requirements of accrediting bodies.
• Completes routine assignments and special projects as directed.
• Prioritizes work according to department and hospital need.
• Attends and participates in department and hospital meetings, in-services, and quality improvement teams.
• Contributes to the accomplishment of department and hospital objectives.
• Projects a positive personal and professional image of the Pre-Access Specialist, Patient Access department, and hospital at all times, under all circumstances.
• Maintains a clean and orderly work area.

Qualifications:

• High School Diploma or equivalent required
• PC literacy, must be able to type 30 wpm with a 95% accuracy
• Excellent organizational, oral & written communication skills required
• At least one year of patient access, insurance verification or related experience preferred
• Medical terminology preferred

• Must be dependable, professional and a team player
• Critical thinking skills
• Solid oral and written communication skills and detailed oriented
• Ability to multi-task and be flexible with job demands
• Energetic, motivated individual that connects well with people