Pre Access Specialist

• Schedules and/or pre-registers OP procedures/appointments from physicians offices, patients, or other ancillary departments via telephone inquiry, fax request or CPOE WQ.

• Obtains appropriate patient demographic, insurance information and clinical information to ensure that appointments are complete and accurate.

• Understands the proper use of the scheduling software.

• Maintains good public relations skills to ensure a positive impression.

• Conducts appointment triage at the time of scheduling to ensure the needs of patients and each clinical specialty are met.

• Provides accurate and complete patient exam preparation instructions.

• Avoids testing conflict with other scheduled exams in accordance with standard protocols.

• Offers scheduling flexibility between all Units and considers patient convenience when making appointments.

• Stays within individual departmental guidelines when scheduling daily patient caseload.

• Performs One Call pre-registration process if speaking directly with the patient.

• Utilizes automated dialer for Pre-Registration process.

• Review incoming fax orders in Trace and indexes accordingly.

• Completes verification, benefit analysis, and authorization for specified OP procedures/appointments directly with the insurance payer.

• Communicate schedule discrepancies with appropriate department.

• Obtains accurate clinical history for appropriate pre-authorized requests.

• Provide necessary clinical information and pertinent demographic information to insurance company either via web or phone call.

• Requires knowledge of appropriate CPT for each procedure.

• Communicate with referring office or hospital department when a discrepancy arises with procedure scheduled.

• Document appropriate authorization number and valid dates for each procedure.

• Begin work on all pre authorizations scheduled out 30 days.

• Communicates payer requirement changes to the pre access lead or management staff.

• Monitor insurance company protocols for authorization changes.

• Work in conjunction with Marketing and SEP Management to provide resources needed for referring office education.

• Perform eligibility and benefit analysis for all admissions, surgeries, and observation services. Obtain authorization as needed from referring physician office and verify for accuracy.

• Follow individual payer matrix to ensure compliance with daily workflow process.

• Use assigned online eligibility software for payer verification and notification.

• Use TRACE tools as needed.

• Update as needed in registration following all standard registration policies and procedures.

• Work with other departments and outside entities to establish a positive working relationship that promotes cooperation and teamwork.

• Communicate with Quality Management on a daily basis to ensure the appropriateness of accounts requiring precertification and follow-up by UM personnel.

• Work closely with the financial counseling unit, including any vendors, in the sharing of account information to minimize potential denials and aid in the financial assistance process.

• Maintain a communication network with physicians offices, internal departments and payers to help obtain needed information and resolve problem accounts.

• Work with PFS and Revenue Cycle departments to complete retro authorization request.

• Provide support and assistance with claims denial due to pre-authorized issues.

• Completes point of service collection process as identified.

• Documents accounts appropriately.

• Adheres to Point of Service Collection policy.

• Uses strong customer service skills that reflect Mission, Vision, and Values statement of the St. Elizabeth Healthcare.

• Maintain strict patient confidentiality at all times

• Promotes cooperation and teamwork

• Speaks clearly and concisely in a courteous and friendly tone of voice.

• Listens carefully to the caller, answers questions, and seeks assistance from others as needed.

• Interacts with managers, co-workers, and other hospital personnel in the sharing of work-related objectives and the need for clarification and/or process improvement.

• Demonstrates a personal commitment to continuous quality improvement through active participation.

Additional Requirements

• Required to attend monthly staff meetings, possible evening or weekend hours.

• Responsible for completing annual hospital and department educational requirements.

• Attends meetings and webinars as assigned.

• Adhere to policy and procedures of St. Elizabeth Healthcare.

• Performs other duties as assigned.

Education, Credentials, Licenses:

• High School Diploma or GED

Specialized Knowledge:

• PC skills, including Word and Excel

• Strong Interpersonal and organization skills

• Proven track record of excellent customer service skills.

• Good typing skills / data entry skills

• Excellent communication skills (both written and verbal)

• Maintain patient confidentiality

• Organization and prioritization skills

Kind and Length of Experience:

• 1-year experience in call center, office, healthcare, or other team-oriented setting.

• Excellent communication and customer service skills

FLSA Status:

Non-Exempt

Right Career. Right Here. If you're looking for the right careers in healthcare, the right place to be is at St. Elizabeth. Join us, and you'll take pride in the level of care we offer our community and dis