Patient Services Specialist | Revenue Cycle
for sections present with real content. Must not repeat job title. Must not include Job ID etc. Must include sections only if posting has real specific content. Must not include filler like "commensurate with experience". Must not include Pay/Schedule/Benefits unless posting actually states them. The posting includes Starting Pay Rate Range $18.27 - $21.00 (Determined by the knowledge, skills, and experience of the applicant.) So we have pay info. Also benefits listed: "Monument Health offers competitive wages and benefits on qualifying positions. Some of those benefits can include: Supportive work cultureMedical, Vision and Dental CoverageRetirement Plans, Health Savings Account, and Flexible Spending AccountInstant pay is available for qualifying positionsPaid Time Off Accrual BankOpportunities for growth and advancementTuition assistance/reimbursementExcellent pay differentials on qualifying positionsFlexible scheduling". So benefits present. Schedule: "Scheduled Weekly Hours 40". So schedule present. Also location: "Primary Location Rapid City, SD USA". Could be included maybe as metadata but not as heading; we can put in a short
. Also department: "Department RCH Revenue Cycle Management Services". Also maybe "Job Category Patient Services Job Family Patient Support". Could be minor metadata. We need sections: About the role? Not present. Responsibilities? The Job Description includes essential functions; we could treat as Responsibilities. Requirements? There's Required Additional Requirements: Education, Experience, Preferred Education, Physical Requirements. Could be Requirements. Qualifications? Might be similar. Skills? Not explicit. Benefits: we have benefits. Pay: we have pay. Schedule: we have schedule. We must not create sections with filler. So we need to include sections only if we have real content. Let's decide sections: - Responsibilities (from Job Description / Universal Essential Functions and Essential Functions For Medication Authorization And Assistant Specialist). We'll combine. - Requirements (Education, Experience, Preferred Education, Physical Requirements). Could also include "Required Additional Requirements". - Benefits (list). - Pay (Starting Pay Rate Range). - Schedule (Scheduled Weekly Hours 40). We could also include "About the role" maybe from Job Summary. The Job Summary is a paragraph describing role. Could be "About the role". That seems appropriate. Thus sections: About the role, Responsibilities, Requirements, Benefits, Pay, Schedule. We must not repeat job title as heading. So headings:
About the role
etc. We need to use- for any list of duties/requirements/benefits. For prose use
. We need to preserve all substantive information, not invent or summarize away detail. Must not omit details. Must include all details from posting. We need to be careful to not lose any specifics like "Collaborate with healthcare providers..." etc. We need to include the Job Summary paragraph as prose under About the role. Responsibilities: need to list duties as bullet points. The posting has many sentences; we can break into bullet points each representing a duty. Must preserve all info. Let's extract duties from "Universal Essential Functions:" and "Essential Functions For Medication Authorization And Assistant Specialist". Also "All other duties as assigned." We'll include that as a bullet maybe. We need to ensure we don't lose any nuance. Let's list duties: From Universal Essential Functions: - Collaborate with healthcare providers, clinical staff, and various departments throughout Monument Health as well as with the patient to secure necessary authorization for services while maintaining compliance with all regulatory requirements. - Accurately verify patient insurance eligibility and benefits coverage, utilizing tools such as Electronic Health Records (EHR), add-on software, direct payer websites, and telephone or fax communications to ensure accurate reimbursement and compliance. - Assess service requests to determine the need for pre-certification, pre-authorization (procedure or medication), or referrals, and communicate effectively with relevant stakeholders to secure approvals prior to the date of scheduled services. - Maintain a strong working knowledge of various insurance payers, payer plans, and program contract requirements to facilitate appropriate insurance verification and authorization processes. - Continuously meet competency requirements to sustain the necessary skills, knowledge, and abilities for role-specific functions, while adhering to productivity and quality performance standards. - Create a positive service experience by being polite, compassionate, and professional with all internal and external customers. - Document pre-authorization information accurately in the EHR system, ensuring that services scheduled by internal and external providers meet all financial clearance criteria and have approved authorization in the time allowed by the payers and programs to prevent denial or penalty assessment. - Engage with departments and clinical staff to communicate the need for pre-authorizations or referrals promptly, working to prevent delays in patient care. May include requests for assistance with managing appeals as well as the facilitation and coordinating peer-to-peer reviews when needed. - Identify high-risk requests that may require financial assistance and counseling and assist patients by providing guidance on available resources, financial assistance, or payment arrangements. - Advocate for patients and providers by addressing challenges related to pre-authorization approvals and denials, working closely with leadership to resolve issues and ensure compliance with financial clearance policies. - Provide backup support for Patient Admissions and Registration as needed. - All other duties as assigned. From Essential Functions For Medication Authorization And Assistant Specialist: - Confirm prescription coverage and coordinate prior authorization, including collecting and submitting required clinical documentation (i.e. provider notes, labs and treatment history) - Stay up to date on patient assistance programs and guide patients through required application documentation. - Coordinate with providers and nursing staff to obtain required signatures and documentation from patients and providers - Serve as a patient advocate by regularly communicating with pharmaceutical companies, providers and patients. - Act as primary contact for patient inquiries about medication authorizations and assistance programs. - Monitor assistance medications to ensure timely delivery and continuous patient access. - All other duties as assigned. We need to avoid duplicate "All other duties as assigned." maybe just one. Now Requirements: Education - High School Diploma/GED Equivalent in General Studies. Preferred Experience - 1+ years in Health Care Services, Customer Service, Patient Scheduling, Patient Billing Experience. Education - Associates degree in Healthcare Related Field (Preferred? Actually it's listed under Preferred Experience? The text: "Preferred Experience - 1+ years in Health Care Services, Customer Service, Patient Scheduling, Patient Billing Experience Education - Associates degree in Healthcare Related Field". Might be ambiguous but we keep both. Physical Requirements: Sedentary work - Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Also maybe "Job Category Patient Services Job Family Patient Support Shift Requires the ability to work assigned schedules and hours as determined by the department Employee Type Regular". Could be included but not required. We'll include Requirements section with bullet points for each. Benefits: list as bullet points: Supportive work culture, Medical, Vision and Dental Coverage, Retirement Plans, Health Savings Account, and Flexible Spending Account, Instant pay is available for qualifying positions, Paid Time Off Accrual Bank, Opportunities for growth and advancement, Tuition assistance/reimbursement, Excellent pay differentials on qualifying positions, Flexible scheduling. Pay: Starting Pay Rate Range $18.27 - $21.00 (Determined by the knowledge, skills, and experience of the applicant.) Schedule: Scheduled Weekly Hours 40. Also location and department maybe as a short paragraph under a meta? Not required as heading. Could include a
with location and department. We must not include boilerplate like EEO etc. Now output HTML fragment. Let's craft:
About the role
The Patient Services Specialist plays a vital role in ensuring timely and accurate patient access to medical services by managing the prearrival prior authorization services. This position enhances patient access to care by ensuring all scheduled medical service requests and referrals are financially cleared prior to the date of service provision through the performance of insurance eligibility validation, plan benefit verification, and any related financial clearance, prior authorization, and pre-determination processes.
Responsibilities
- Collaborate with healthcare providers, clinical staff, and various departments throughout Monument Health as well as with the patient to secure necessary authorization for services while maintaining compliance with all regulatory requirements.
- Accurately verify patient insurance eligibility and benefits coverage, utilizing tools such as Electronic Health Records (EHR), add-on software, direct payer websites, and telephone or fax communications to ensure accurate reimbursement and compliance.
- Assess service requests to determine the need for pre-certification, pre-authorization (procedure or medication), or referrals, and communicate effectively with relevant stakeholders to secure approvals prior to the date of scheduled services.
- Maintain a strong working knowledge of various insurance payers, payer plans, and program contract requirements to facilitate appropriate insurance verification and authorization processes.
- Continuously meet competency requirements to sustain the necessary skills, knowledge, and abilities for role-specific functions, while adhering to productivity and quality performance standards.
- Create a positive service experience by being polite, compassionate, and professional with all internal and external customers.
- Document pre-authorization information accurately in the EHR system, ensuring that services scheduled by internal and external providers meet all financial clearance criteria and have approved authorization in the time allowed by the payers and programs to prevent denial or penalty assessment.
- Engage with departments and clinical staff to communicate the need for pre-authorizations or referrals promptly, working to prevent delays in patient care. May include requests for assistance with managing appeals as well as the facilitation and coordinating peer-to-peer reviews when needed.
- Identify high-risk requests that may require financial assistance and counseling and assist patients by providing guidance on available resources, financial assistance, or payment arrangements.
- Advocate for patients and providers by addressing challenges related to pre-authorization approvals and denials, working closely with leadership to resolve issues and ensure compliance with financial clearance policies.
- Provide backup support for Patient Admissions and Registration as needed.
- Confirm prescription coverage and coordinate prior authorization, including collecting and submitting required clinical documentation (i.e. provider notes, labs and treatment history).
- Stay up to date on patient assistance programs and guide patients through required application documentation.
- Coordinate with providers and nursing staff to obtain required signatures and documentation from patients and providers.
- Serve as a patient advocate by regularly communicating with pharmaceutical companies, providers and patients.
- Act as primary contact for patient inquiries about medication authorizations and assistance programs.
- Monitor assistance medications to ensure timely delivery and continuous patient access.
- All other duties as assigned.
Requirements
- Education: High School Diploma/GED Equivalent in General Studies.
- Preferred Experience: 1+ years in Health Care Services, Customer Service, Patient Scheduling, Patient Billing Experience.
- Preferred Education: Associates degree in Healthcare Related Field.
- Physical Requirements: Sedentary work - Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.
Benefits
- Supportive work culture
- Medical, Vision and Dental Coverage
- Retirement Plans, Health Savings Account, and Flexible Spending Account
- Instant pay is available for qualifying positions
- Paid Time Off Accrual Bank
- Opportunities for growth and advancement
- Tuition assistance/reimbursement
- Excellent pay differentials on qualifying positions
- Flexible scheduling
Pay
Starting Pay Rate Range $18.