Patient Access Specialist - FT - Days

About the Organization

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).

Qualifications

• High School Graduate or Equivalent
• BLS certification through the American Heart Association for Healthcare Providers
• Experience required in using EMR systems, insurance verification, eligibility, and electronic billing
• Billing and Coding Certification preferred
• 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 & NCCI 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

Responsibilities

• Deliver a dynamic customer experience to all customers and demonstrate a strong commitment to service excellence
• Obtain demographic, insurance, and medical information to ensure an accurate and complete registration
• Perform insurance verification, data collection and documentation
• Determine medical necessity for services based on established medical criteria
• Identify patient financial responsibilities and collect applicable monies
• Act as liaison to all internal and external customers to facilitate access to hospital services
• Secure all necessary documentation to register the patient's visit
• Review all documentation to ensure coding by provider is supported and accurate
• Apply 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
• Conduct internal audits of patient charges and corresponding documentation, report and track on a monthly basis
• Submit claims and work rejections for claims submission, daily
• Check for data errors and use them as examples for educating team members
• Determine problems that resulted in a rejected claim, resolve, advise on procedural changes to implement and prevent further such rejects
• Resubmit/refile, print records as needed to appeal rejected claims, as necessary
• Check coding and post charges
• Adhere to contractual requirements of Medicare, Medicaid, and managed care plans
• Scrub and review charges before claims are submitted
• Review surgical claims and post-op visits to ensure full reimbursement is captured
• Run daily update and insurance exception reports
• Review and correct, re-scrub rejected claims
• Perform other duties as assigned

Team Member Competencies

• Establishing Relationships: Builds effective networks, working relationships, and alliances in order 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.
• 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.
• Being a Champion for Change and Innovation: Supports people in their efforts to try new things. Thinks 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.

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
• Travel as needed

Threshold Requirements

These threshold requirements are required and completed on a yearly basis:

• Annual Joint Commission mandatory education requirements, in-service and health requirements including attendance at new employee orientation
• TB/PPD Surveillance Program
• Maintenance of required professional licensing and/or certification(s)