Specialist

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Scheduled Weekly Hours:

Job Description:

• The Patient Access Specialist provides superior customer service to both internal and external customers regarding insurance coverage, referral and prior authorization information and patient liability. The role of the Patient Access Specialist is critical in kicking off the revenue cycle process with the pre-registration and financial clearance of scheduled patients. The Patient Access Specialist is responsible for patient financial management and clearance on assigned pre-service populations. Specifically, this specialist is responsible for ensuring that all accurate and complete registration, demographic information, and insurance coverage is secured prior to services being rendered, and that all patient liability estimates and expectations are communicated and attempted. In addition, the Patient Access Specialist should serve as a functional expert for peers and collaborates with department representatives to ensure that all necessary information is provided to patients prior to service.

• Major Responsibilities:
  1. Represents Gundersen's high standards for customer service in all telephone and face-to-face communication through courteous, patient and respectful conduct and conversation, while meeting the needs of all customers encountered.
  2. Responsible for maintaining data integrity in the pre-registration of patients, and verifying/updating demographics and insurance accurately and completely in order to drive a timely billing process.
  3. Works collectively with insurance carriers, patients and internal contacts to identify referrals and/or prior authorization requirements, and assists with securing these requirements before services are provided, resulting in timely reimbursement and final disposition of claims.
  4. Independently conducts research and manages issues related to securing and interpreting required information on department-specific procedures from a variety of resources prior to contacting patients regarding their estimated liabilities
  5. Explains topics of insurance coverage, treatment costs, and financial assistance opportunities to patients and/or family members. Utilizes Revenue Integrity and available software tools to provide patients with cost estimates.
  6. Notifies scheduled patients of liabilities and payment expectations prior to date of service as determined by insurance benefits and coverage limits via electronic verification and patient estimation tools.
  7. Requests payment on identified liabilities during the pre-service financial clearance process and according to department guidelines.
  8. Identifies, communicates, and collects on patients' outstanding balances and bad debt during pre-service financial discussions.
  9. Identifies and appropriately refers uninsured and under-insured patients to Financial Counselors for assessment and assistance.
  10. Actively participates in analysis of work processes and provides feedback to appropriate system level managers to improve the overall registration process and enhance patient satisfaction.
  11. Works closely with clinical departments to ensure that all necessary pre-service information is communicated timely and effectively.
  12. Serves as a functional expert for peers across the patient access continuum.
  13. Meets daily productivity and quality standards associated with job requirements.
  14. Keeps skills and education current through periodic in-services on service excellence, registration policies and insurance guidelines, and other information related to the position, including all federal and state insurance regulations.
  15. Demonstrates and maintains competency in computer skills related to insurance verification and eligibility systems in validating the reimbursement of services rendered.
  16. Adheres to Gundersen's mission statement, customer service standards, and all system-wide policies and procedures.
  17. Demonstrates overall knowledge of revenue cycle processing, insurance payer and benefit types, and pre-registration and financial clearance functional requirements.
  18. Performs other job-related responsibilities as requested.

  Education and Learning:
  REQUIRED
  High School Diploma or equivalency
  Successful completion of defined core competency testing.

  Work Experience:
  REQUIRED
  1 year experience in an office setting requiring customer service responsibilities.
  
  

  
  DESIRED
  1 year prior healthcare experience and prior experience working with patient eligibility and sponsorship. Registration scheduling experience.

  Age Specific Population Served:
  Nonage Specific (N/A)
  
  
  
  OSHA Category:
  Category III - No employees in this job title have a reasonably anticipated risk of occupational exposure to blood and/or other potentially infectious materials.
  
  
  
  Environmental Conditions:
  Not substantially exposed to adverse environmental conditions (as in typical office or administrative work).

  Physical Requirements/Demands Of The Position:

  Sitting Continually (67-100% or 8 hours)

  Reaching - Shoulder Level Rarely (1-5% or .5 hours)

  Reaching - Below Shoulder Continually (67-100% or 8 hours)

  Reaching - Above Shoulder Rarely (1-5% or .5 hours)

  Repetitive Actions - Fine Manipulation Frequently (34-66% or 5.5 hours)

If you need assistance with any portion of the application or have questions about the position, please contact the recruiter listed below:

Primary Recruiter:

Recruiter Email Address:

Equal Opportunity Employer