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Position Title: Pre-Access Specialist Il
Job Code: 2263
FLSA Status: Non-Exempt
Entity: Mercy Health Youngstown
Reports To: Manager of JACBCC
It is expected that all of the duties and responsibilities of this position will be performed in a manner that reflects the values of Mercy Health. The mission of Mercy Health is to extend the healing ministry of Jesus by improving the health of our communities with emphasis on people who are poor and under-served.
SUMMARY OF JOB RESPONSIBILITIES:
Under minimal supervision of a Supervisor / Manager / Lead, the Specialist Il is responsible for performing revenue cycle tasks necessary to ensure compliance, patient safety, and excellent customer service. This position is fast-paced, requiring multitasking and effective problem solving skills. The following tasks must be performed timely and accurately: assign appropriate MRNs, schedule correct procedure appointments based on verbal requests or written orders (knowledge of medical terms and human anatomy preferred), demonstrate knowledge of Mercy Health system and services offered, validate patient demographic and insurance information, screen for medical necessity to ensure Medicare compliance, document necessary pre-certifications / authorization for service, verify and accurately document patient insurance eligibility and benefits, calculate and collect patient liabilities (money) and provide exceptional customer service. The Specialist Il has many customers, including patients, insurance payers, clinical department staff and physician offices. It is expected that the Specialist Il will foster positive relationships with all customers in an effort to provide quality patient care. The Specialist Il will act as an example to other teammates and serve as a shift lead in the absence of supervisory personnel. The Specialist Il should remain in full compliance with all departmental, institutional and regulatory policies and procedures. The roles and responsibilities of this job support the mission, vision, values and strategies of Mercy Health.
High School graduate or GED required.
Graduate of business school or 1 year of college preferred.
Medical terminology and knowledge of insurance preferred.
1-2 years of healthcare experience preferred.
I -2 years of extensive customer service experience preferred.
Experience in multiple areas of pre-access (scheduling, pre-registration, financial clearance) preferred.
Effective in fast-paced environment and demonstrates strong problem-solving skills.
Excellent communication skills, computer proficiency, typing, phone etiquette and customer service skills required.
Knowledge of healthcare terms and revenue cycle processes, including insurance regulations, preferable.
KNOWLEDGE AND SKILLS:
Strong data entry skills required, as well as demonstrated ability to work in multiple systems accurately and efficiently, such as scheduling and registration systems, document imaging, scanning, medical necessity and data quality monitoring.
CHAA (Certified Healthcare Access Associate) certification preferred.
PRNCIPAL JOB ACCOUNTABILITIES:
Schedules the correct procedure at the appropriate facility and appropriate time, while also ensuring assignment of proper patient types
Accurately obtains / validates / documents patient demographic, insurance and clinical information and assigns correct payer plan code
Accurately pre-registers patients, including selection of proper medical record number for patient safety
Completes insurance verification and eligibility checks
Calculates patient liabilities and actively collects and processes patient payments
Corrects registration errors identified during pre-registration
Receives and processes physician orders received via fax, Order Facilitator, or any other method available for receiving pre-service orders Follows up on missing orders, ensures that requested orders are received and on file prior to services being rendered
Collects and accurately documents initial pre-certification / authorization information if available when scheduling
Performs medical necessity / compliance checks to ensure services meet medical necessity based on Medicare Local Coverage Determination (LCD) and communicates ABN requirements to physician offices if scheduled service(s) is not medically necessary
Refers patients to financial counselors when additional financial counseling or payment arrangements are needed
Accurately cancels and/or reschedules appointments as requested
Meets productivity requirements to ensure excellent service is provided to customers Demonstrates knowledge of entire Mercy Health system and services offered
Demonstrates problem solving skills related to scheduling, financial clearance and patient liability
Organizes work / resources to accomplish objectives and meet deadlines
Proactively communicates issues or potential issues involving customer service and process improvement opportunities to management
Maintains excellent public relations with patients, families, physicians and hospital staff
Ensures that patients, their families, visitors, customers and staff members are treated with kindness and respect
Maintains the privacy and security of all confidential and protected health information. Uses and discloses only that information which is necessary to perform the function of the job.
Interfaces with other key internal and external staff to obtain necessary information to address PreAccess accounts.
Demonstrates the willingness and ability to work collaboratively with others for concise and timely flow of information.
Reports issues and trends to appropriate management personnel and works collaboratively to develop solutions.
Participates in all educational activities, and demonstrates personal responsibility for job performance.
Takes initiative for learning new skills and willingness to participate and share expertise on projects, committees and other activities, as deemed appropriate.
Uses supplies and equipment effectively and efficiently.
Consistently demonstrates a positive and professional attitude at work.
Maintains stable performance under pressure. Handles stress in ways to maintain relationships with patients, customers and co-workers.
Maintains compliance with established corporate and departmental policies and procedures. Meets or exceeds expectations for data quality, POS collections, customer service and productivity.
Maintains satisfactory attendance record and punctuality record as set forth by Mercy Health.
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.
Mercy Health is an equal opportunity employer.
We'll also reward your hard work with:
Great health, dental and vision plans
Prescription drug coverage
Flexible spending accounts
Life insurance w/AD&D
An employer-matched 403(b) for those who qualify.
Paid time off
And a lot more
Scheduled Weekly Hours:
Other (United States of America)
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All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Mercy Health Youngstown, which is an Affirmative Action and Equal Opportunity Employer, please email email@example.com. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at firstname.lastname@example.org.
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