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Form of workStatus: Full Time
Shift: Mon-Fri 7:30a-4:30p
Exempt: No
Other information:
FACTORS RELATING TO THE JOB
A. Experience, Knowledge and Skill
- Education Required: High School Diploma; One year of previous experience in healthcare field or customer service requir ed, Bachelor’s degree can be substituted for one year of experience. Experience in healthcare admissions, registration, or billing preferred.
- Knowledge, Skills, and Abilities: Medical Terminology desired; ability to communicate over the telephone; excellent customer service skills. Must be able to interpret complex documents related to insurance benefits. Must be able to read and understand physician’s referrals. Requires judgement to accurately establish patient identity, assign insurance information according to payer and facility guidelines, associate orders with scheduled services.
- Intermediate computer skills required; ability to operate a computer using Word, Excel, and email, fax machines, printers, and copiers.
- Physical Skill Required: Must have considerable hand-eye coordination to operate a computer. Must be able to sit or stand for long periods of time. Must be able to bend or squat to patient’s level. Must be able to lift and carry supplies to department and to equipment (example: reams of paper to copiers/fax machines).
Strength: Light Push: Occasionally Pull: Occasionally
Carry: Occasionally Lift: Occasionally Sit: Constantly
Stand: Occasionally Walk: Occasionally
B. Work Complexities
1. Complexities and Difficulty of Work: Must be able to complete all scheduling functions quickly and correctly while maintaining good customer service with persons involved.
2. Seriousness of Errors: There is opportunity to make serious errors related to patient identification, patient safety, and legal compliance. This position requires careful attention to details while performing duties.
C. Working Conditions
1. Adverse Working Conditions: G enerally pleasant working conditions; must use critical thinking skills to prioritize work; stress resulting from time pressure and fast pace.
D. Contacts
1. Constant contact with the general public or patients during the scheduling process via phone.
2. Regular contact with clinic staff, providers, and clinic leadership team.
3. Frequent contact with insurance companies.
E. Responsibilities
- Responsibility for the safety of others: Keep desk drawers closed; wires away from walking areas; folders and papers out of walking areas. All paths must be clear of obstructions.
- Responsibility for Confidential Information: Responsible for safeguarding confidential patient and employee financial and medical information and records.
- Responsibility for Performance of Work without immediate supervisor: Under general supervision, works independently on routine work; supervisor is available to give advice and instructions on new or routine tasks.
- Responsibility for Supervision of Others: None
Responsibilities:
ESSENTIAL DUTIES
- Ensures timely access to medical care by completing patient scheduling, insurance verification, and authorization/pre-certification processes in an accurate, efficient, and timely manner and according to NOPG guidelines and payer rules and regulations.
- Schedules according to provider orders and provider preference forms and reviews insurance documents; verifying coverage and updating all insurance information in the patient’s electronic medical record by ensuring accurate entry of insurance and demographic information during scheduling to facilitate appropriate billing.
- Completes all scheduling processes according to department patient identification procedures including but not limited to using two patient identifiers, reviewing patient identification documents, and interviewing the patient to ensure patient safety.
- Ensures legal compliance, patient safety, and system financial integrity by performing state license verification, sanction and exclusion verification as well as NPI verification on all providers not already listed in the hospital information system.
- Demonstrates working knowledge of payer rules and guidelines including but not limited to, Patient Rights, Medicare Secondary Payer Questionnaire (MSPQ), and, to ensure accurate scheduling, insurance verification, and registration in order to support the Patient Access responsibilities within the revenue cycle and comply with JCAHO, CMS, and DHH requirements.
- Demonstrates basic knowledge of payer types including, but not limited to, Medicare, Medicaid, Other Governmental, Worker’s compensation, managed care, and Self-pay in order to schedule patients according to department procedures and payer requirements.
- Demonstrates understanding of basic terminology as it relates to insurance guidelines including but not limited to Co-payment, Co-insurance, Deductible, Allowable/Allowed amount, Payable Rates, Payer Notification, Pre-Certification, Prior Authorization, Guarantor, Primary/Secondary/Tertiary Coverage, and Explanation of Benefit
- Demonstrates understanding of basic medical terminology in order to recognize Buzz Words and transferring calls timely.
- Works effectively to ensure the highest regard to customer service is given to every patient, customer, provider office, and every department that utilizes the Patient Access Center.
OTHER DUTIES:
- Interacts with relevant departments including but not limited to Ancillary departments, Revenue Integrity, Financial Services, Information Technology, Health Information Management, and NOPG clinics to problem solve and coordinate any concerns related to patient identification, registration, scheduling, insurance verification, or billing issues.
- Maintains patient confidentiality according to Hospital policies and procedures.
- Assists in patient conflict resolution to ensure timely access to care as well as to facilitate a positive patient experience.
- Enhances professional growth by participating in education programs and department meetings as required.
5. Follows associated North Oaks Health System and North Oaks Physician Group compliance programs and federal and state regulatory guidelines.
6. Attends staff meetings.
7. Performs other duties as assigned.
