PATIENT ACCESS CLINIC SPECIALIST

Description

STATEMENT OF PURPOSE

The Clinic Patient Access Specialist is responsible for verification of all patient accounts in an effort to assist with registration to ensure accuracy to decrease insurance claim denials. This position is dually responsible for prior authorization and referral process for all specialty providers with in the JRMC Clinic. This position is responsible for verifying the accuracy and completeness of all registrations and assisting in the education of daily activity of the clinic patient access department and internal referring of JRMC providers to JRMC and out of our service area. This position has a great understanding of the admitting and registration process and is able to work in all areas of admissions.

This is a full time, benefited position working 80 hours per 2 week pay period. Hours are Monday - Friday, no nights or weekends.

JOB FUCTIONS

• Verifies patient insurance information with insurance companies to determine eligibility, type of coverage, and primary payer.
• Knowledge of medical terminology is a must.
• Ensures and enters the pre-authorizations for Surgery and Radiology of JRMC providers.
• Assists the department supervisor in working patient access work queues, checking for accuracy and completeness.
• Verifies all registration or admissions of patient clinic accounts are correctly completed.
• Works closely with clinic direct patient care professionals for prior authorizations process of additional services that the patient may need.
• Reviews medical policies for JRMC providers prior to the patient’s service date.
• Works closely with JRMC hospital based departments to ensure referrals and prior authorizations are obtained prior to service taking place.
• Works closely with the business office and HIM to validate all patient accounts.
• Maintains communication and promotes cooperation with other departments in regards to patient accounts.
• When required, will be assigned to work in various admission areas; interviews patients, gathering information including but not limited to demographic data, insurance information and emergency notification, and obtains appropriate signatures. Functions as the telephone switchboard when required. Assists in the scheduling of patient for the clinic and rehab departments.
• Discusses payment arrangements with patients, receives payments and prepares receipts.
• nteracts with patients of all age groups (infants, pediatrics, adolescents, adults, and geriatrics) while performing duties.
• Conducts department in-services as requested by department manager.
• Works on PC including Microsoft programs (Word, Excel, Outlook) projects.
• Maintains registration and scheduling proficiency program.
• Will assist with departmental policies and procedures
• Will become or is a Preceptor.
• Is back up for Financial Counseling and HB Patient Access Specialist.
• Will schedule, registers and assist in patient access team needs.
• Performs other related duties as assigned or requested.
  
  

Requirements

QUALIFICATIONS/REQUIREMENTS FOR THIS POSITION: (PATIENT ACCESS SPECIALIST)

• PREPARATION AND TRAINING - High school level of knowledge preferred. Encouraged to have background and strong knowledge of medical terminology. Must be able to follow oral or written orders. Good written and verbal communication skills are needed.
• WORK EXPERIENCE - One year clerical experience and insurance background is required.
• ATTENDANCE - Punctual and regular attendance is an essential responsibility of each employee at JRMC. Employees are expected to report to work as scheduled, on time and prepared to start working. Employees are also expected to remain at work for their entire work schedule.
• ANALYTICAL ABILITY - Analytical ability is required. Good organizational skills are needed.
• INDEPENDENT JUDGEMENT - Independent judgment is often required; moderate consequences of errors of judgment.
• CONTACTS WITH OTHERS - Social sensitivity and effective communication is required with public contact and co-workers; compliance to behavior standards is required.
• SUPERVISING THE WORK OF OTHERS None
• RESPONSIBILITY FOR WELFARE OF OTHERS - Infrequently provides for the physical well-being of the patient which may result in serious consequences, i.e. emergency calls such as to call codes.
• MENTAL/VISUAL EFFORT - Must be able to concentrate amid distractions; think clearly under pressure; and work regularly requires high level of mental/visual effort. Must be able to speak and write the English language in an understandable manner. Must be in good general health and demonstrate emotional stability. Visual acuity necessary for performing routine procedures.
• WORKING CONDITIONS - Works in well-lit office with some inconvenience caused by crowded work area; area subject to temperature discomforts and noise. May be required/requested to work on shifts other than the one for which hired. Participates in and complies with JRMC Safety Management Program. Maintains knowledge of and observes Standard Precautions. Practices aseptic techniques whenever appropriate. OSHA Job Classification: This position is defined as a Category II: Employee does not have exposure to bloodborne pathogens.
• PHYSICAL AND SENSORY EFFORT - Must be able to occasionally accomplish movement of computer paper and forms that are a maximum of 50 pounds. Occasional reaching, stooping, bending, kneeling, and crouching. Constant sitting is required to perform the major responsibilities of this job.
• PROMOTION - No formal line of promotion.
• PHYSICAL REQUIREMENT - These are physical requirements of the position that may be performed as part of daily duties. Inability to meet one or more of these physical requirements will not automatically disqualify a candidate or employee from the position. Upon request for a reasonable accommodation, JRMC may be able to adjust or excuse one or more of these requirements, depending on the requirement, the essential functions to which it relates, and the proposed accommodation.
  
  

Employee Requirements

• Visual Observation - Continuously
• Standing - Rarely
• Walking - Occasionally
• Sitting - Continuously
• Hands and Finger Dexterity - Frequently
• Reaching with Hands and Arms - Frequently
• Climbing - Rarely
• Stooping/Kneeling/Crouching/Crawling - Rarely
• Hearing/Listening - Continuously
• Tasting or Smelling - Rarely
• Working Inside - Continuously
• Working Outside - Rarely
• Working in Extreme Heat - Rarely
• Working in Extreme Cold - Rarely
• Working with Hazardous Materials - Rarely
• Noise - Rarely
• Working in Dirt/Dust - Rarely
• Driving - Never
  
  

Lifting: -

• Up to 10 pounds - Rarely
• Up to 25 pounds - Rarely
• Up to 50 pounds - Never
• Up to 75 pounds - Never
• Up to 100 pounds - Never
• Over 100 pounds - Never
  
  

Carrying: -

• Up to 10 pounds - Rarely
• Up to 25 pounds - Rarely
• Up to 50 pounds - Never
• Up to 75 pounds - Never
• Up to 100 pounds - Never
• Over 100 pounds - Never
  
  

Pushing: -

• Up to 10 pounds - Rarely
• Up to 25 pounds - Rarely
• Up to 50 pounds - Rarely
• Up to 75 pounds - Rarely
• Up to 100 pounds - Rarely
• Over 100 pounds - Rarely
  
  

Pulling: -

• Up to 10 pounds - Rarely
• Up to 25 pounds - Rarely
• Up to 50 pounds - Never
• Up to 75 pounds - Never
• Up to 100 pounds - Never
• Over 100 pounds - Never