DESCRIPTION OF POSITION:

• The patient access specialist processes incoming and/or outgoing referrals, manages provider schedules, obtain prior authorizations for indicated procedures/tests/medications, schedule outside procedures/testing, and performs related processing duties for all patients being served by respective clinic. Duties are done in Practice Management and EMR system as appropriate. As a member of the clinic team the patient access specialist is trained in performing a wide range of skilled administrative and clerical duties. Reports to the Office/Practice Manager

RESPONSIBILITIES AND DUTIES:

SERVICE

• Employee is familiar with CPT coding and Medical Necessity of testing. Employee ensures criteria met prior to scheduling testing and/or procedures, including surgery.
• Employee familiar with different insurance companies and their requirements in terms of precertification for surgery, testing, and procedures. Employee documents and forwards applicable information to facility or in office.
• Employee is knowledgeable about insurance processing and is able to explain deductibles, co-insurance, co-payments, and how processing occurs.
• Employee handles incoming referrals from iMed or faxes. Imports the referrals and works to obtain prior records necessary for scheduling the patient. Creates new patient accounts. Responsible for notifying referring provider of the appointment.
• Answers phone with correct salutation. Takes messages when appropriate.
• Records all messages into electronic EMR after completing request. If patient does not leave required information, patient access representative must call patient back in order to obtain.
• Greets each patient warmly and cheerfully.
• Verifies patient information is correct, demographics and insurance coverage. If changes are required, changes the information into the Practice Management system.
• Checks in the patient in the Practice Management system.
• Updates and scans updated information and forms into appropriate Practice Management or EMR system.
• In the event a patient does not show for scheduled appointment, a “No Show” letter must be generated in the patient chart in the EMR system. Letter should be mailed to patient. Message in the EMR should be sent to the physician of the no show.
• 3 days prior to appointment, confirmation calls should be made to the patient. Patient should be called daily until patient or family member personally confirms.
• Scan and attach all paperwork received into EMR system and attach and send appropriately.
• Collect faxes and scan if testing, distribute into boxes if appropriate.
• Pulls all orders from checkout function.
• Schedules all testing after obtaining precertification per physician checkout orders.
• Completes and sends medical records request per physician orders.
• Completes all referrals through the EMR following correct protocol.
• Runs and reconciles receipts following established protocol.
• Scan and attach all paperwork received into EMR system and attach and send appropriately.
• Collect faxes and scan if testing. Other than testing, distribute into boxes if appropriate.
• Is trained to perform all checkout duties.

FINANCE

• Verification of insurance should be performed and noted on the careslip

SAFETY/QUALITY

• Performs and safely operates all equipment according to the manufacturers’ instructions and protocols.
• Able to perform administrative duties (i.e. scheduling, registration, insurance authorization, answering phone, schedule testing, refer patients as ordered by physician or mid level provider etc…).

JOB ACCOUNTABILITIES – Other:

• Performs other job duties as assigned.

EDUCATION AND WORK EXPERIENCE

• High school diploma or equivalent required.
• Knowledge and training in medical terminology, keyboarding, and computer skills preferred.
• Basic skills in Microsoft Office preferred.
• Previous experience preferred in the areas of scheduling.
• Computer literacy, required.
• Broad range of administrative and technical skills in the context of the healthcare environment.
• Impacts activities in other work areas on a frequent basis and contributes in multiple work areas.
• Make decisions based on departmental policy.
• Demonstrates critical thought process and can work independently.
• Provides feedback to assist with decision making process.
• Works well with others.
• Documents detailed information in patient chart.
• Requires listening skills to maintain cooperative associations.

Physical Demands/Work Environment

• Office based work
• Must be able to exchange accurate information with patient, family, peers and medical personnel.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.