Access Lead- UPMC West Shore

UPMC•Mechanicsburg, PA

About The Position

The Access Lead coordinates and leads the daily functions of a designated work area, providing direction and support to staff and escalating concerns to management when needed. The role facilitates statistical reporting and data analysis to support UPMC guidelines and serves as the primary on-site information source and advocate for financial matters. The Access Lead supports UPMC’s core values and departmental policies, serves as a resource and troubleshooter, represents management, and helps train and orient staff. The role monitors patient flow and staffing needs, supports accurate patient and insurance information, verifies coverage and precertification, works with clinical and ancillary teams to address reimbursement issues, and completes revenue reports to support successful billing.

Requirements

High school diploma or GED and at least 3 years of experience in a related fiscal, admissions, or registration function; or an associate degree and 1 year of experience; or an equivalent combination of education and experience.
Medical terminology knowledge.
Experience with third-party health care coverage and a strong understanding of managed care regulations.
Strong interpersonal, organizational, and communication skills.
Ability to remain professional and courteous when dealing with sensitive issues and stressful circumstances.
Ability to problem-solve effectively and make independent decisions.
Prior experience using personal computers and various office equipment.
Knowledge and skills necessary to provide care or interact appropriately with patients of all ages.
Ability to assess data reflecting patient status and interpret information needed to identify age-specific patient requirements.
Ability to provide care needs as described in department policy and procedure.
Act 34 clearance.

Responsibilities

Support UPMC core values and guiding principles, and follow departmental policies, procedures, and goals while treating others with dignity and respect.
Serve as an advocate, resource, troubleshooter, and designated leader at specific work sites.
Represent management and make decisions as empowered.
Train and orient new staff to the department work area, and provide ongoing education and communication.
Provide management with regular feedback about personnel, department issues, and concerns within areas of direct responsibility.
Monitor patient flow and respond to changes in workload, patient volume, and staffing levels by planning services accordingly.
Ensure precertification requirements are met before treatment.
Update patient demographic and insurance information in the system as necessary.
Verify insurance benefits with available carriers using electronic verification or telephone when not already completed.
Work with clinical staff and ancillary departments to resolve reimbursement issues.
Advise clinical staff when a referral to a participating health care facility may be appropriate.
Complete revenue reports within established time frames and take action to support successful billing.
Perform in accordance with system-wide competencies and behaviors.
Perform other duties as assigned.