Pre Access-Specialist- Authorization

Job Summary

Demonstrate respect, dignity, kindness and empathy in each encounter with all patients, families, visitors and other employees regardless of cultural background. The Pre-Access Specialist is a system-wide position responsible for securing a patient account from the initial interaction through the performed exam. They are responsible for the scheduling, pre-registering, verification, authorization and pre collection process. This position exists to enhance customer service, while securing accounts according to standard protocols and payer requirements.

Job Description

• Completes verification, benefit analysis, and authorization for specified OP procedures/appointments directly with the insurance payer.
• Communicate schedule discrepancies with appropriate department.
• Obtains accurate clinical history for appropriate pre-authorized requests.
• Provide necessary clinical information and pertinent demographic information to insurance company either via web or phone call.
• Requires knowledge of appropriate CPT for each procedure.
• Communicate with referring office or hospital department when a discrepancy arises with procedure scheduled.
• Document appropriate authorization number and valid dates for each procedure.
• Begin work on all pre authorizations scheduled out 30 days.
• Communicates payer requirement changes to the pre access lead or management staff.
• Monitor insurance company protocols for authorization changes.
• Work in conjunction with Marketing and SEP Management to provide resources needed for referring office education.
• Perform eligibility and benefit analysis for all admissions, surgeries, and observation services.
• Obtain authorization as needed from referring physician office and verify for accuracy.
• Follow individual payer matrix to ensure compliance with daily workflow process.
• Use assigned online eligibility software for payer verification and notification.
• Use TRACE tools as needed.
• Update as needed in registration following all standard registration policies and procedures.
• Work with other departments and outside entities to establish a positive working relationship that promotes cooperation and teamwork.
• Communicate with Quality Management on a daily basis to ensure the appropriateness of accounts requiring precertification and follow-up by UM personnel.
• Work closely with the financial counseling unit, including any vendors, in the sharing of account information to minimize potential denials and aid in the financial assistance process.
• Work with PFS and Revenue Cycle departments to complete retro authorization request.
• Provides support and assistance with claims denial due to pre-authorized issues.
• Completes point of service collection process as identified.
• Documents accounts appropriately.
• Adheres to Point of Service Collection policy.
• Uses strong customer service skills that reflect Mission, Vision, and Values statement of the St. Elizabeth Healthcare.
• Maintain strict patient confidentiality at all times.
• Promotes cooperation and teamwork.
• Speaks clearly and concisely in a courteous and friendly tone of voice.
• Listens carefully to the caller, answers questions, and seeks assistance from others as needed.
• Interacts with managers, co-workers, and other hospital personnel in the sharing of work-related objectives and the need for clarification and/or process improvement.
• Demonstrates a personal commitment to continuous quality improvement through active participation.
• Schedules and/or pre-registers OP procedures/appointments from physician’s offices, patients, or other ancillary departments via telephone inquiry, fax request or CPOE WQ.
• Obtains appropriate patient demographic, insurance information and clinical information to ensure that appointments are complete and accurate.
• Understands the proper use of the scheduling software.
• Maintains good public relations skills to ensure a positive impression.
• Conducts appointment triage at the time of scheduling to ensure the needs of patients and each clinical specialty are met.
• Provides accurate and complete patient exam preparation instructions.
• Avoids testing conflict with other scheduled exams in accordance with standard protocols.
• Offers scheduling flexibility between all Units and considers patient convenience when making appointments.
• Stays within individual departmental guidelines when scheduling daily patient caseload.
• Performs “One Call” pre-registration process if speaking directly with the patient.
• Utilizes automated dialer for Pre-Registration process.
• Review incoming fax orders in Trace and indexes accordingly.

Additional Requirements

• Required to attend monthly staff meetings, possible evening or weekend hours.
• Responsible for completing annual hospital and department educational requirements.
• Attends meetings and webinars as assigned.
• Adhere to policy and procedures of St. Elizabeth Healthcare.
• Performs other duties as assigned.

Education, Credentials, Licenses

• High School Diploma or GED.
• PC skills, including Word and Excel.
• Strong Interpersonal and organization skills.
• Proven track record of excellent customer service skills.
• Excellent communication skills (both written and verbal).
• Maintain patient confidentiality.
• Organization and prioritization skills.

Kind And Length Of Experience

• 1-year experience in call center, office, healthcare, or other team-oriented setting.
• Excellent communication and customer service skills.