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Patient Access Specialist Interventional RadiologyJob ID 148362 Date posted 06/19/2018
Essential Duties & Responsibilities including but not limited to:
Ensures that all information necessary for proper financial reimbursement for high dollar patient care is analyzed and submitted to insurance companies for approval prior to the patient's date of service. Collaborates with insurance companies when necessary to proactively validate benefits, eligibility and authorization requirements. Communicates with patients to assure they understand their payment obligations and steps necessary to meet these obligations, while maintaining a positive patient experience.
Accesses work queues and reports and reviews patient accounts to determine financial clearance status of specific patient services. Takes action on those services without financial clearance.
Ensures demographic and patient contact information is complete and verified with the patient or patient representative.
Verifies the guarantor type and information and ensures it is assigned to the account correctly. This includes personal/family relations, workers compensation insurance, third parties, behavioral health or others as required.
Ensures all possible coverages are created and verified, through electronic or manual methods, and all discrepancies are resolved. Validates that coverages are assigned to appropriate visit.
Collects and validates order-related information including office visit, radiology and surgical orders. Follows up with ordering provider to verify CPT codes.
Verifies Primary Care Physician (PCP) information and ensures appropriate PCP referrals are in place for the provider and service by checking electronic systems and calling PCP offices. Enters and links referrals in system.
Processes referrals when necessary, assuring proper tracking and redirection when appropriate. Understands each clinical department?s referral certification protocols and ensure referrals are certified at the appropriate level.
Using system activities and functions, identifies non-covered services and prepares proper Advance Notice Beneficiary (ABN) or waiver for registration team. Documents account for registrar action.
Analyzes clinical documentation in support of ordered procedure(s) and submits precertification requests through various insurance fax lines, phone systems and web portals. Follows up on pending accounts and involves ordering provider offices as needed to obtain approvals.
Escalates challenging accounts to provider representative to ensure accounts are approved at least two weeks prior to patient appointment/surgery.
Collaborates with clinical departments to facilitate scheduling of approved procedures and rescheduling of non-urgent non-certified cases. Professionally communicates outcome to patient when needed.
Escalates non-certified urgent cases to appropriate clinical departments and leadership for approval to proceed or rescheduling.
Verifies covered benefits, including remaining hospital days, carve out coverages and benefit limits of visit and/or timeframe.
Contacts patients, providers and insurance companies to validate data, collect missing information and resolve information discrepancies,
Understands clinical guidelines for payors requiring authorization to better build cases for authorization requests and provide feedback to clinical departments on required notes.
Communicates with patients and discusses their financial clearance status when necessary. Explains the status of any services not financially cleared and advises patients of the proper resolution steps, including self-payment. Directs patients to Lahey Financial Counselors when appropriate.
Works with the Financial Counselors, clinical departments, outside providers, third party insurers and any other individual or entity to assist in resolving patient financial clearance questions or problems in the most effective and positive manner possible.
Researches claim edits and payment denials related to financial clearance and works closely with the Lahey Patient Financial Services staff to resolve these denials. Communicates resolution to patients.
Initiates patient scheduling activities by prioritizing and accessing a variety of sources, including patient phone calls, orders, recall lists, scheduled order work queues and MyChart.
Utilizes a variety of information sources to schedule, reschedule and cancel patient appointments. Information sources include online questionnaires, offline materials and subgroup searches.
Establishes working relationship with staff of assigned clinical departments. Understands and correctly applies unique clinical department scheduling protocols.
Remains current on scheduling protocols and applies judgment, or seeks management assistance, to ensure safe patient care when clinical department scheduling protocols do not meet patient needs.
Ensures all required key patient scheduling and registration information is captured and verified. Key information includes referring physician information, insurance coverage, demographics and contact information.
Identifies and communicates to Patient Access management issues that may impact the timeliness and accuracy of patient appointments and subsequent patient care.
Efficiently registers patients, capturing and verifying all required information in order to identify the patient, contact the patient, and receive proper reimbursement for services on initial claim submission.
Ascertains, creates and assigns the guarantor for each patient, including personal/family relations, workers compensation insurance, third parties, behavioral health or others as required.
Identifies, records and verifies patient insurance coverage using real time eligibility (RTE); reviews the insurer's response to each verification request and takes appropriate action based on this response.
Applies the appropriate guarantor and insurance to each patient visit.
Communicates financial clearance status to patients. Advises patients of self-pay status and payment responsibility and schedules patients with Financial Counseling as needed.
Registers patients presenting for visits. Explains the registration process to patients and responds to patient questions.
Processes patient co-payments, co-insurance, deductibles and balances due. Safeguards cash, checks and receipts and reconciles cash drawer at end of each business day.
Assists patients with Kiosk check-in as needed.
Completes the Medicare Secondary Payor Questionnaire for each patient and adjusts patient coverage based on results.
Instructs patients and obtains signatures on consent forms, financial forms and other documents required by the clinical department; distributes documents to patients; scans, processes and records receipt of all documents collected during registration encounter.
Counsels patients regarding non-covered services, obtaining signatures on Advance Notice Beneficiaries (ABNs) and waivers.
Monitors patient waiting area for a smooth, efficient registration flow. Advises patients of potential delays and takes steps to ensure a pleasant patient experience.
Completes registrations on inpatient units who may be missing information from their original registration
Responds to patient concerns and potential patient safety issues accordingly. Recognizes health conditions that are a possible risk to others and adheres to appropriate established procedures to help contain risk.
Assures a neat, orderly registration desk and patient waiting area, securing all confidential patient information.
High school degree or equivalent
Licensure, Certification & Registration: None
Prior experience in a business setting providing customer service, while processing and verifying electronic demographic, financial or other business-related information and data.
Skills, Knowledge & Abilities:
Able to work successfully in a fast-paced, multi-task environment, where some independent decision making is necessary. Able to process electronic information and data accurately and efficiently.
About Lahey Health
At Lahey Hospital & Medical Center, as one of the world's premier health care organizations, we provide superior health care leading to the best possible outcome for every patient. We exceed our patients' high expectations for service each day. We also help advance medicine through research and the education of tomorrow's health care leaders
We care for our patients with compassion and openness, unsurpassed expertise, a drive for continuous learning improvement, and with respect, caring, teamwork, excellence and commitment to doing our personal best.
Join our team and our mission of excellence by applying today!
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