Patient Access Specialist - Primary Care JupLakes136

Position Summary

The Patient Access Specialist will be responsible for delivering a dynamic customer experience to all customers and demonstrating a strong commitment to service excellence. The role involves obtaining demographic, insurance, and medical information to ensure accurate and complete registration, performing insurance verification, data collection and documentation, determining medical necessity for services, identifying patient financial responsibilities, acting as a liaison to internal and external customers, securing necessary documentation, reviewing documentation to ensure coding by providers is supported and accurate, applying coding rules and using CPT & ICD 10 codes and appropriate modifiers, assisting in educating physicians and staff on documentation requirements for proper reimbursement, conducting internal audits of patient charges and corresponding documentation, submitting claims, working rejections for claims submission, checking for data errors, resolving issues that result in rejected claims, resubmitting/refiling, printing records as needed to appeal rejected claims, checking coding and posting charges, adhering to contractual requirements of Medicare, Medicaid, and managed care plans, scrubs and reviews charges before claims are submitted, reviewing surgical claims and post-op visits to ensure full reimbursement, running daily updates and insurance exception reports, reviewing and correcting rejected claims, and performing other duties as assigned.

Team Member Competencies

• Establishing Relationships
• Peer Support
• Inspiring and Motivating Others
• Demonstrating Emotional Intelligence
• Acting with Integrity
• Championing for Change and Innovation

Physical Requirements

• Daily contact with insurance companies and/or patients, by writing, telephone, via computer programs and/or in person within an office environment
• Sitting for long periods of time, also stooping, bending, standing and stretching
• Might require lifting up to 20 lbs
• Manual dexterity for typing and computer data entry

Threshold Requirements

• 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)