Lead Consumer Access Specialist
About the role
Manages relationships with clinical partners to ensure open communication between clinical, ancillary, and consumer access departments.
Provides timely and continual coverage of assigned work areas to offer prompt patient service and availability for all clinical partner registration needs.
Provides on-call support as needed.
Contacts insurance companies to verify insurance eligibility and benefits, and determine coverage before scheduled appointments and during or after care for unscheduled patients.
Obtains pre-authorizations from third-party payers and accurately enters required authorization information in the system.
Sets up patient accounts for all services by obtaining critical demographic elements and ensuring accuracy.
Performs Medicare compliance reviews, eligibility checks, and completes Medicare Secondary Payer Questionnaires.
Ensures patient accounts are assigned the appropriate payor plans and updates financial assessments, eligibility, and benefits.
Creates accurate estimates to maximize up-front cash collections and advises patients of expected costs, collecting payments or making appropriate payment agreements.
Aids the department supervisor with quality audits, mentoring staff, assisting with departmental training, and staff schedules.
Collaborates with case management staff as necessary and ensures patients have logistical information necessary to receive their services.
Documents all conversations with patients and insurance representatives in the appropriate fields.
Actively attends department meetings and promotes positive dialogue within the team.
Responsibilities
- Manages relationships with clinical partners
- Ensures timely coverage of assigned work areas
- Verifies insurance eligibility and benefits
- Obtains pre-authorizations from third-party payers
- Sets up patient accounts
- Performs Medicare compliance reviews
- Ensures patient accounts are assigned the appropriate payor plans
- Creates accurate estimates
- Aids in quality audits and staff training
- Collaborates with case management staff
- Documents conversations with patients and insurance representatives
- Attends department meetings
Requirements
- Associate's degree in business or related field preferred
- High school diploma or equivalent required
- 1+ years of customer service experience
- 1+ years of revenue cycle experience
- 2+ years of direct patient access experience preferred
Skills and Abilities
- Mature judgement in dealing with patients, physicians, and insurance representatives
- Intermediate knowledge of Microsoft programs and familiarity with database programs
- Ability to operate general office machines such as computer, fax machine, printer, and scanner
- Ability to effectively learn and perform multiple tasks, and organize work in a systematic and efficient fashion
- Ability to communicate professionally and effectively, both verbally and written
- Ability to adapt in ever changing healthcare environment
- Follows complex instructions and procedures with a close attention to detail
- Adheres to government guidelines such as CMS, EMTALA, and HIPAA and corporate policies
- Exceptional customer service skills
- Advanced understanding of insurance knowledge and benefits
- Advanced understanding of hospital electronic medical record (EMR) system
- Basic medical terminology
- Bilingual – English/Spanish
Knowledge
- Mature judgement in dealing with patients, physicians, and insurance representatives
- Intermediate knowledge of Microsoft programs and familiarity with database programs
- Ability to operate general office machines such as computer, fax machine, printer, and scanner
- Ability to effectively learn and perform multiple tasks, and organize work in a systematic and efficient fashion
- Ability to communicate professionally and effectively, both verbally and written
- Ability to adapt in ever changing healthcare environment
- Follows complex instructions and procedures with a close attention to detail
- Adheres to government guidelines such as CMS, EMTALA, and HIPAA and corporate policies
- Exceptional customer service skills
- Advanced understanding of insurance knowledge and benefits
- Advanced understanding of hospital electronic medical record (EMR) system
- Basic medical terminology
- Bilingual – English/Spanish
Qualifications
- Associate's degree in business or related field preferred
- High school diploma or equivalent required
- 1+ years of customer service experience
- 1+ years of revenue cycle experience
- 2+ years of direct patient access experience preferred
Skills
- Mature judgement in dealing with patients, physicians, and insurance representatives
- Intermediate knowledge of Microsoft programs and familiarity with database programs
- Ability to operate general office machines such as computer, fax machine, printer, and scanner
- Ability to effectively learn and perform multiple tasks, and organize work in a systematic and efficient fashion
- Ability to communicate professionally and effectively, both verbally and written
- Ability to adapt in ever changing healthcare environment
- Follows complex instructions and procedures with a close attention to detail
- Adheres to government guidelines such as CMS, EMTALA, and HIPAA and corporate policies
- Exceptional customer service skills
- Advanced understanding of insurance knowledge and benefits
- Advanced understanding of hospital electronic medical record (EMR) system
- Basic medical terminology
- Bilingual – English/Spanish
Benefits
Includes medical, dental, vision insurance, life insurance, disability insurance, paid time off, 403-B retirement plan, whole person well-being resources, mental health resources and support, pet benefits, career development, and more.
Pay
$18.69 - $29.89 per hour
Schedule
Full time, night shift (Monday-Thursday)
Additional Information
Overnight 8p-6a shift
Physical Requirements
View physical requirements
Pay Range
$18.69 - $29.89 per hour