Pre-Cert: Access Services Specialist

POSITION SUMMARY:
The Access Service Specialist is responsible for verifying and updating insurance, patient demographics, determining prior authorization requirements, obtaining referrals for outpatient and inpatient services, benefit counseling, estimates and collection. The position is accountable for multiple electronic work queues in performing their duties. The incumbent works with internal and external customers, including patients, families, third party payers, clinical staff, and review organizations to accomplish their objectives.
This position represents UW Health Northern Illinois and the Revenue Cycle team by adhering and upholding the UW Health Respect for people commitments and UW Health Service Excellence Standards of Behavior in providing the highest quality service to our customers. They will be friendly, knowledgeable, flexible, and reliable. They will listen to, anticipate, recognize, and satisfy our customer's needs. We will improve our Access Service process while ensuring the highest level of satisfaction, keeping our promises and commitments, and demonstrating our commitment through respect, knowledge, responsiveness, and courtesy. They will support their co-workers, engage in positive interactions, demonstrate friendliness by smiling and making eye contact when greeting all customers, provide helpful assistance in anticipating and responding to the needs of our customers and staying calm under pressure to deal effectively with difficult people.
EDUCATION/TRAINING:
High school diploma or GED preferred. At least 2 years' experience in the healthcare or related field with emphasis on insurance prior authorization and referral processes preferred.
LICENSURE/CERTIFICATION:
N/A
EXPERIENCE/SKILLS/ABILITIES:

• Must be detail oriented and accurate.
• Ability to use good judgments in highly emotional and demanding situations
• Ability to react to frequent changes in duties and volume of work
• Excellent oral and written communication skills and strong patient interviewing techniques by telephone or in person
• Ability to comprehensively and accurately capture patient demographic, insurance information, detail-oriented
• Ability to manage multiple tasks with ease and efficiency
• Self-starter with a willingness to try new ideas
• Ability to work independently with minimal supervision and be result oriented
• Positive, can-do attitude coupled with a sense of urgency
• Effective interpersonal skills, including the ability to promote teamwork
• Strong problem solving skills
• Ability to ensure a high level of customer satisfaction including employees, patients, visitors, referring physicians and external stakeholders
• Ability to use various computer applications including EPIC and MS Office
• Basic math skills and knowledge of general accounting principles
• Maintains confidentiality of sensitive information
• Broad knowledge of health care business office practices and principles
• Solid understanding of coordination of benefits regulations
• Knowledge of medical and insurance terminology, CPT, ICD coding structures
• Knowledge of Business Office policies and procedures
• Knowledge of local, state and federal healthcare regulations
• Securing Valuables
• Ability to type 35 words per minute preferred.

ESSENTIAL FUNCTIONS:

1. Via telephone or in person, determine the guarantor, collect patient demographic and billing or insurance information and verify coverage via RTE or other methods in a courteous and professional manner. Determines the appropriate payer plans and files orders to drive insurance proration and discounts to ensure accurate and timely reimbursement.

1. Contacts insurance companies to obtain benefit information and requirements related to pre-certification, pre-existing condition clauses, referral requirements and enter benefit and pre-certification information into Health Link.

1. Answer and educate patient, medical staff and other appropriate SwedishAmerican Health System personnel regarding prior authorization and referral processes. Maintain awareness that some questions may be sensitive issues with the patient and approach them accordingly. Identify patient insurance priority.

1. Develop and maintain knowledge of insurance plans, contractual relationships, and insurance mergers and acquisitions. Maintain thorough knowledge of payer/plan master files to ensure that the correct payers/plans are attached to the patient.

1. Provides clinical documentation to insurance companies to support medical necessity of scheduled services.

1. Review pre-certification, referral information, and co-payment requirements and inform patient or physician office of such requirements, as applicable.

1. Obtains a financial statement and financial responsibility form as necessary

1. Collects deductibles and prepayments as required.

1. Refers patients with limited insurance or high financial liability to a Financial Counselor, and refers patients to the Government Program Coordinator to determine if referral to alternate funding sources is appropriate.

1. Work claim edits/work queues associated with registration errors.

1. Researches and appeals payment denials, as appropriate.

Our Commitment to Diversity, Equity, and Inclusion
UW Health is committed to being a diverse, inclusive and anti-racist workplace and is an Equal Employment Opportunity, Affirmative Action employer. Our integrity shines through in patient care interactions and our daily work practices as we work to embrace the knowledge, unique perspectives and qualities each employee and faculty member brings to work each day. Applications from Black, Indigenous and People of Color (BIPOC) individuals, LGBTQ+ and non-binary identities, women, persons with disabilities, military service members and veterans are strongly encouraged. EOE, including disability/veterans.