Specialist

Job Overview:

The Patient Access Specialist supports the Patient Access Department by providing key operational functions to identify opportunities and minimize risk. The Patient Access Specialist position plays a key role within the health system by ensuring all steps are taken to financially secure accounts prior to or during service. A core function of this position is to ensure that authorization requirements are met prior to service. The Patient Access Specialist provides direct and indirect support to department by analyzing data to identify issues and opportunities, reduce denials and improve processes.

The Patient Access Specialist has in-depth knowledge of payer authorization requirements, protocols for obtaining and confirming appropriate authorization for the clinical services rendered and minimizing financial risk. The Patient Access Specialist has extensive knowledge of payer requirements and is able to clearly understand and articulate with clinical and non-clinical staff.

Qualifications:

Required:

• High School Diploma
• Minimum of 5 years in Patient Access role
• Extensive knowledge of payer authorization requirements
• Knowledge in all aspects of Patient Access work flows
• Advanced Excel experience required
• Medical terminology and computer skills

Preferred:

• College degree

Scheduling Requirements:

• Day Shift
• Full-Time

Essential Functions:

• Provides excellent customer service to all patients, colleagues and other external and internal customers
• Strong understanding of prior authorization requirements for various services
• Experience in authorization submission workflow and related technology (Real Time Authorization, Payer portals, TPA authorization forms, Call to payers to update/upgrade existing authorization
• Communicate clearly with clinical staff and payer representatives to authorize services
• Review script and/or medical service documentation to ensure authorizations match services provided
• Interviews patients, family members and other responsible parties to gather pertinent information
• Meets and exceeds department goals including accuracy and productivity
• Demonstrates proficiency in the entire pre-admission, registration, and financial clearance processes
• Demonstrates initiative and motivation in role; proactively identifies and resolves problems in an appropriate manner and escalates issues to leadership when necessary
• Utilize system generated reports to analyze data
• Analyze denial data to determine root cause, identify issues and areas of opportunity
• Create tracking and trending reports
• Provide summary findings and recommendations to leadership teams
• Assist with creating action plans to address and resolve issues pertaining to incorrect insurance and authorization denials
• Develop reports to quantify the value and financial risk for each area
• Audit and review work flow, patient processing and quality standards
• Reflects commitment to building a supportive work environment and maintains a positive attitude
• Works closely and professionally with clinical staff and ancillary departments to foster a team environment
• Participate in training through the development of training tools, presentations at department in-services or staff meetings, or through the training of registration staff outside of the patient access department

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Choosing RWJBarnabas Health!

RWJBarnabas Health is the premier health care destination providing patient-centered, high-quality academic medicine in a compassionate and equitable manner, while delivering a best-in-class work experience to every member of the team. We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health.

RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education.

RWJBarnabas Health is an Equal Opportunity Employer