Patient Access Specialist - Referrals and Authorizations

Ranked #1 for Safety, Quality and Patient Satisfaction, Jupiter Medical Center is the leading destination for world-class health care in Palm Beach County and the greater Treasure Coast. Outstanding physicians, state-of-the-art facilities, innovative techniques and a commitment to serving the community enables Jupiter Medical Center to meet a broad range of patient needs. Jupiter Medical Center is the only hospital in Palm Beach, Martin, St. Lucie and Indian River counties to receive a 4-star quality and safety rating from the Centers for Medicare & Medicaid Services (CMS). Education: High School Graduate or Equivalent, Billing and Coding Certification preferred Experience/Qualifications: Experience required in using EMR systems, insurance verification, eligibility, and electronic billing. Requires general and specific knowledge of health insurance plans and interpretation of health insurance benefits. Extensive knowledge of current billing and coding rules and regulations and use of CPT & ICD 10 codes including appropriate modifiers for Radiation Oncology, Infusion and Oncology Surgery. Ability to read, understand, and adhere to CMS & NCCN guidelines and compliance. Ability to maintain confidentiality. Experience in a customer support role. Medical terminology knowledge. Proficient skills in computer applications such as Microsoft Office. Ability to set priorities and manage time effectively. Flexible, service oriented, and dedicated. Exceptional communication skills both verbally and in writing. Superior organizational skills, attention to detail, and able to multi-task. Strong interpersonal skills, listening and ability to carefully follow directions. Position Summary The Patient Access Specialist will be responsible for delivering a dynamic customer experience to all customers and demonstrate a strong commitment to service excellence. The Patient Access Specialist is responsible for obtaining demographic, insurance, and medical information to ensure an accurate and complete registration. Performing insurance verification, data collection and documentation. Determine medical necessity for services based on established medical criteria. Identifying patient financial responsibilities and collecting applicable monies. Acting as liaison to all internal and external customers to facilitate access to hospital services. Secures all necessary documentation to register the patient's visit. Reviews all documentation to ensure coding by provider is supported and accurate. Applies all coding rules and use of CPT and ICD 10 codes and appropriate use of modifiers. Assist manager in educating physicians and staff in requirements of documentation for proper reimbursement. Assists in conducting internal audits of patient charges and corresponding documentation, reports, and tracks on a monthly basis. Submit claims and works rejections for claims submission, daily. Checks for data errors and uses them as examples for educating team members. Determines problems that resulted in a rejected claim, resolve, advises on procedural changes to implement, and prevent further such rejects. Resubmits/refiles, print records as needed to appeal rejected claims, as is necessary. Check coding and post charges. Adhere to contractual requirements of Medicare, Medicaid, and managed care plans. Scrubs and reviews charges before claims are submitted. Reviews surgical claims and post-op visits to ensure we capture a full reimbursement. Run daily update and insurance exception reports. Review and correct, re-scrub rejected claims. Performs other duties as assigned. Team Member Competencies Establishing Relationships Builds effective networks, working relationships, and alliances to collaborate effectively within department and organization. Can relate to all kinds of people regardless of background; find topics and common interests that can be used to build rapport with others. Peer Support Provides guidance and feedback to help others strengthen knowledge/skills needed to accomplish tasks, solve problems, and perform effectively within the team. Inspiring and Motivating Others Fosters commitment and cohesiveness by facilitating cooperation and working as a team within the organization toward goal accomplishments. Work well with others, build consensus, and ensure cooperation to complete tasks and positive workflow. Demonstrating Emotional Intelligence Exercises self-leadership, self-awareness, and self-regulation; manages emotions so that they are expressed appropriately; leads others by showcasing adaptability, empathy, and social skills. Acting with Integrity Interacts with others in a way that is seen as direct and truthful; ensures confidence in individual and organizational motives and representations. Acts in a way that is consistent with personal and organizational values by keeping confidence, promises, and commitments. Clearly states goals and beliefs; informs people of their true intentions, does what they say they will do; follows through on commitments. Being a Champion for Change and Innovation Supports people in their efforts to try new things. Things creatively, generates novel and valuable ideas and uses these ideas to develop new or improved processes. Accepts new ways of doing things and adapts to change. Communicating Effectively Speaks and writes clearly, conveys information in a concise, organized, and logical manner. Is adept at tailoring the message to fit the interests and needs of the audience. Listens attentively and exercises tact, discretion, and diplomacy when interacting with members of the department and organization. Promoting Diversity and Inclusion Treats all people with dignity and respect. Demonstrates an open-minded approach to understanding people regardless of their gender, age, race, national origin, religion, ethnicity, disability status, or other characteristics. Challenges bias and intolerance. Develops all-inclusive groups in the realms of social interaction and communication. Shows respect for the beliefs of others; encourages and promotes practices that support cultural diversity; discourages behaviors or practices that may be perceived as unfair, biased, or critical toward people with certain backgrounds. Physical Requirements Involves daily contact with insurance companies and/or patients, by writing, telephone, via computer programs and/or in person within an office environment. Requires sitting for long periods of time, also stooping, bending, standing and stretching. May require lifting up to 20 lbs. Must have manual dexterity for typing and computer data entry. Threshold Requirements These threshold requirements are required and completed yearly basis. Annual Joint Commission mandatory education requirements, in-service and health requirements including attendance at new employee orientation, TB/PPD Surveillance Program and Maintenance of required professional licensing and/or certification(s). Our growth is creating great opportunities! Our team is expanding, and we want to hire the most talented people we can. Continued success depends on it! So once you've had a chance to explore our current open positions, apply to the ones you feel suit you best and keep track of both your progress in the selection process, and new postings that might interest you! Thanks for your interest in working on our team!! Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.