Care Access Patient Precertification Specialist

The Care Access Patient Management role is the third stage of the care Access career path. It is part of a multi-faceted team providing services to York Hospital and its affiliates on and off campus. Each team member is responsible to exercise the mission and vision of YH in providing safe patient and family centered care that is compassionate, timely, effective, efficient, and of the highest quality and patient experience. The role includes emergency registration, switchboard, call center, pre-certification and referral responsibilities.

Essential Duties and Responsibilities (but not limited to):

•          Maintain courteous, inviting, professional demeanor at all times with patients, family members, caregivers, providers, and co-workers. Always maintain York Hospital's code of Loving Kindness

•          Collaborate with other team members to ensure patients, family and other team members needs are met

•          Respect patient confidentiality guidelines without exception understanding a violation is grounds for disciplinary action

•          Professional appearance and demeanor at all times

•          Excellent written and verbal communication skills

•          Ability to work constructively in a team environment contributing actively to team goals

•          Exercise mature decision making and multi-tasking abilities and be able to work independently

•          To remain calm and personable in a fast paced and sometimes difficult setting

•          Support the timely flow of patient care by being a reliable, flexible, and dependable team member.

•          Schedule patients/families' ancillary/support service needs (e.g. interpreter/social/nutrition services) per provider's orders/referrals.

•          Demonstrate a willingness to learn and adapt to the dynamics of a constantly changing health care environment. 

•          Competency in performing duties and responsibilities as Care Access Patient Concierge and Patient Navigation roles

•          Understand multiple insurance requirements for referrals and pre-certifications for ordered appointments and procedures by specialists and primary care

•          Provide information, guidance, and solutions to all patients.

•          Outbound calls to insurance companies and related practices to advocate for the patient's needs

•          Ability to navigate through all applications needed to complete patient pre-registrations and appointments

•          Clearly communicate any requirements for a scheduled procedure to a patient or family member

•          Create registration accounts for all new and established patients, verify, collect, and update required

information. This information includes patient's demographics, email accounts, insurance information, emergency contact and Primary Care Information. This person must be able to collect and enter this data with a high degree of accuracy

•          Run insurance eligibility, understand eligibility report, make necessary calls to insurance companies, patients to ensure accurate billing for best patient practices to include Surgery, Special Procedures, Physical and Occupational Therapies (inpatient and outpatient), Breast Care, Imaging and all others as assigned

•          Collect co-payments required by patient's insurance coverage, which includes the responsibility for accurate documentation in the patient record as well as accountability of monies for Finance Office as required.

•          Understand the admissions processes for patients being transferred from the Emergency area to a Med Surge Bed, Surgical Procedure, Special Procedure or Cath Lab Procedure

•          Assume the "charge" responsibilities as a team lead when necessary

•          Other duties/responsibilities as deemed necessary, which may include schedule or location changes

Team Responsibilities and Duties:           

•        Adheres to Human Resources Policies and Procedures regarding absenteeism, successful team orientation and professional behavior

•        Remains professional in appearance and adheres to dress code per team policy

•        Provides support to achieve team goals and effectively contributes to the team process

•        Performs inter-departmental in-services as requested by the team

•        Demonstrates ability to be flexible with responsibilities and schedules as needed

•          Demonstrates a positive attitude and readiness to embrace and apply change

•        Attend daily huddles/monthly meetings to discuss overall performance with team.

Physical Requirements:

The incumbent in this position typically has to stand approximately 20% of the time, walk 20% of the time, and sit 60% of the time associated with a typical office environment.  In addition, the person is using touch or feel 80% of the time, and reaches with their arms or hands approximately 80% of the time, requiring the dexterity for use of a computer keyboard, and is talking or hearing 100% of the time.

Competencies Required:

• Planning/Organizing
• Dependability

• Multitasking
• Problem-solving
• Oral Communication
• Teamwork
• Professionalism
• High energy
• Follow-through
• Customer Service
• Collaboration
• Interpersonal skills

• Qualifications/ Education/Experience:

High school diploma or GED, higher education preferred.  One year related experience in customer service and/or training in a health care practice setting preferred; or equivalent combination of education and experience.  Knowledge of medical terminology, prior phone customer service or book keeping experience recommended. 

YORK HOSPITAL IS AN EQUAL OPPORTUNITY EMPLOYER.