PATIENT ACCESS ONCOLOGY SPECIALIST

STATEMENT OF PURPOSE

The 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. They are responsible for verifying the accuracy and completeness of all registrations and assisting in the education of daily activity of the patient access department. This position has a great understanding of the admitting and registration process.

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 accuracy of the prior authorizations for Infusions and Oncology treatments/series for non JRMC provider services and ensures and enters prior authorization for JRMC providers.
• Reviews all JRMC oncology and OP nursing accounts for medical policies prior to service.
• Reviews FDA approval for pharmaceuticals used in treatments prior to services.
• Maintains an extensive knowledge of prior authorization processes and policies by keeping up to date of insurance company policy changes, bulletins, FDA updates, etc.
• Assists the department supervisor in working patient access work queues, checking for accuracy and completeness.
• Verifies all registration or admissions of patient accounts are correctly completed.
• 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.
• Discusses payment arrangements with patients, receives payments and prepares receipts.
• Interacts with patients of all age groups (infants, pediatrics, adolescents, adults, and geriatrics) while performing duties.
• Responds appropriately to emergency situations i.e Code Blue, fire alerts, stat calls, etc.
• Conducts department in-services as requested by department manager.
• Works on PC including Microsoft programs (Word, Excel, Outlook) projects.
• Maintains registration proficiency program. Assists supervisor and manager with quality reviews.
• Performs other related duties as assigned or requested.
• Will assist with departmental policies and procedures
• Is the back-up JRMC clinic provider insurance specialist and other Patient Access Specialist.

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

1. PREPARATION AND TRAINING - High school level of knowledge preferred. Must be able to follow oral or written orders. Good written and verbal communication skills are needed.

2. WORK EXPERIENCE - One year clerical experience and insurance background is required.

3. 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.

4. ANALYTICAL ABILITY - Analytical ability is required. Good organizational skills are needed.

5. INDEPENDENT JUDGEMENT - Independent judgment is often required; moderate consequences of errors of judgment.

6. CONTACTS WITH OTHERS - Social sensitivity and effective communication is required with public contact and co-workers; compliance to behavior standards is required.

7. SUPERVISING THE WORK OF OTHERS - None

8. 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.

9. 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.

10. 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.

11. 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.

12. PROMOTION - No formal line of promotion.

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