Patient Access Specialist (Insurance) - PRN

DESCRIPTION OF POSITION :

Under the direction of the Patient Access Supervisor this employee is responsible for promoting a caring and compassionate environment that allows Lake Charles Memorial Hospital to provide an individualized experience to our patients.

This employee is devoted to promoting excellent patient and provider relations that encourage a lasting connection. This position gives our patients the access to the care they need by ensuring all scheduled and unscheduled procedures have been authorized by the payer.

As well as providing a patient estimate prior to services, when possible, to ensure point of service collections are completed in accordance with established departmental policies and procedures.

SUPERVISION : Reports directly to the Patient Access Supervisor

RESPONSIBILITIES AND DUTIES :

• Employee is knowledgeable of the LCMH Financial Assistance program and is well versed and able to give a clear definition of the program to all customers.
• Employee is able to recognize when someone may need assistance and offers assistance without hesitation.
• Employee provides application and provides details as to what information will be needed to process a complete application.
• Quantifies applicable patient portions on each patient and discuss financial obligations. Is able to comfortable negotiate with the patient to meet their needs as well as their obligations.
• Employee completes patient estimates using Clearance.
• Employee is knowledgeable of CPT and procedure codes and is able to accurately complete estimates.
• Uses Clearance on all applicable patients and only excludes those that have Medicaid, Medicare and a secondary insurance, and those patients who qualify for full coverage under financial assistance.
• Employee strives to meet cash collection goals.
• Employee is knowledgeable about insurance processing and is able to explain deductibles, co-insurance, co-payments and how processing occurs.
• Employee uses PCA (Compliance Advisor) for all applicable patients by entering the appropriate diagnosis and CPT codes to ensure payor coverage.
• Employee clearly documents the necessity of an ABN so that all staff on front end comprehends what steps need to be taken.
• Employee clearly documents all actions on accounts to ensure the success of any employee who touches the account in any manner.
• Employee documents the name of the insurance company, phone number(s), website, and reference numbers given.
• Employee also scans appropriate documentation to the patients account for future reference.
• Employee pays close attention to detail ensure that any pre-existing periods, policy riders, or low coverage policies are addressed prior to the procedure or notifies financial counseling when patients are admitted as an emergent patient.
• Employee completes all scheduled accounts within a timely manner not to exceed 5 days prior to the scheduled date.
• Employee notifies physician s office staff of authorization requirements timely to ensure authorization can be obtained 3 days prior to the procedure.
• Employee provides notification to management when an account has reached 3 days out and does not have an authorization so that management can assist if possible.
• Also keeps management up to date daily until the day prior to the procedure so that a discretionary decision can be made regarding the procedure being postponed.
• Employee meets acceptable productivity standards working a minimum of 55 accounts per day.
• Employee verifies benefits are active and quantifies patients benefit levels including but not limited to : Deductibles, co-insurance, co-payments, life-time maximum, yearly out of pocket, pre-existing, policy riders, and non-covered services.
• Employee submits timely notification to all insurance companies of patients that have been admitted to the facility in order to meet notification requirements.
• Verifies correct patient type versus orders, ensures order has a status listed.
• When a status is not listed employee will follow up with the physician s office to obtain a corrected order.

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job.

The incumbents may be requested to perform job-related tasks other than those stated in this description.

EDUCATION AND WORK EXPERIENCE

• High School graduate or GED certificate.
• Previous work experience in healthcare or medical insurance environment preferred.
• Basic office and keyboarding skills and the ability to use computer, printer, fax machine, scanner and calculator.
• Basic math skills for collection and reconciliation purposes.
• Proficient skills and understanding of Word and Excel.
• Ability to use multiple databases and hospital specific software.
• Interpersonal skills to interact effectively with patients from various backgrounds in a professional, enthusiastic, courteous and caring manner.
• Appropriate phone etiquette.
• Complete understanding of time of service collections and collection goals. Basic knowledge of medical terminology and insurance / managed care program regulations.
• Ability to read, write and speak intelligible English; Ability to communicate with patients, family, peers and medical personnel;

Basic math skills and appropriate phone etiquette.

Requires emotional stability and resilience; Must be adaptable to change, be decisive, and demonstrates foresight; Exhibits organizational and leadership ability.

Physical Demands / Work Environment

• Work may require evenings, nights, weekends, holidays and / or a flexible schedule depending on the needs of the unit / department / service.
• Requires professional written and verbal communication and interpersonal skills.
• Ability to deal with stressful situations and conflict resolution.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Experience Memorial is more than a slogan, it s the care we provide our patients and it s the commitment to our community and our team members.

As a nationally certified Great Place to Work, at Lake Charles Memorial Health System you will have the opportunity to be a part of an organizational culture that supports not only exceptional patient care but also the well-being and professional growth of our employees.

Join us and be a part of a team where your contributions are valued, your growth is nurtured, and your success is celebrated.