Lead Patient Access - Full-time with Benefits

Frederick Health • Frederick, MD

7d • $18 - $26

About The Position

Support and incorporate into job performance, the Frederick Regional Health System (FRHS) compliance program including the following all regulatory requirements and the FRHS Standards of Behavior. Under the direction of the department manager, the team leader is to provide general oversight and support to the daily workflow of the Patient Access referral and authorization department, contribute towards the hiring process, employee evaluations/reviews, training/mentoring staff, and perform same duties/tasks as the referral and authorization specialists within the department outlined in the required knowledge, skills, and abilities, below. Examples of essential functions: Accuracy & Quality: Consistently produces work that is detailed, accurate, organized, and of high quality. Demonstrates and encourages staff to commit to high standards Investigates and identifies deficiencies and provides recommendations and resolutions. Creates and/or revises workflows to optimize the department’s quality, productivity and support to FHMG and FHH Communication: Communicates effectively, appropriately, and professionally to all staff and patients in a credible manner Ability to understand and effectively communicate in both verbal and written form, in the English language Uses active listening skills while communicating when mentoring/supporting staff and patients Information Management: Utilizes technology to manage and report information in an effective and efficient manner Lead will provide fact base verbal, written, and electronic resources of information to make appropriate decisions with good judgment Planning & Scheduling: Organizes workflows, processes, and schedules according to the department’s standards of procedure while allowing contingencies, to ensure that the department’s continual support to FHMG and FHH Anticipates necessary project and workflows using forward thinking, when there are events outside of the usual standards of the department Financial responsibility: Verify and document accurate insurance eligibility, benefits, authorization requirements, and patient cost share estimates, when applicable, in a timely manner. Provides, when applicable, Frederick Health’s financial assistance program and contact information to the FA department. Assist department manager in reducing denied claims by reviewing financial spreadsheets provided by the central billing office. Teamwork: Contributes valuable ideas, opinions, and feedback in an open and candid manner Reliable in commitments made to others Easily adaptable to change Displays a positive work attitude and motivates others Ability to multitask throughout the day Train, assist, and mentor staff willingly and effectively with a satisfactory retention outcome

Requirements

• Proficient knowledge in the use of: Hardware: Keyboard, fax/copier, 10 key calculator, printer/scanner, phone, PC Software: Computer medical software program, Right Fax, call queue, Teams, Excel, Word, Outlook, Power Point, Waystar, Craneware
• Meditech capabilities: ability to compose and send workload messages, enter and revise patient and insurance demographics, enter referrals and authorizations within the patient data or visit data field, scan and upload documents, find and understand referral orders, able to find clinical information within EMR, find historical records, navigate and work within worklists, able to document within Meditech while meeting HIPPA guidelines
• Applications: API, UKG, reporting services, Bswift, Frederick health website, IPeople downtime, Managed Care Corner, PEP, Isilonnas Folder
• Professional demeanor: precise verbal and written skills, demonstrates ability to read and write and understand the English language, effectively and professionally interacts with staff and patients
• Hygiene: Well-groomed and care for cleanliness and hygiene, dresses in office appropriate attire
• Sanitation: Ability to maintain good housekeeping to assigned workstation and items provided.
• Personal ability: Detailed oriented, ability to analyze data and apply analytics to optimize department workflow and functionality, meets deadlines, ability to multitask, ability to appropriately prioritize tasks, work independently with minimal to no supervision, uses good judgment, ability to meet HIPPA and state regulations regarding security and confidentiality, familiarity with CPT and ICD10 codes and medical terminology, understanding of insurance plan types and the difference between them, houses written resources to support downtime implementation
• Referral Specialist Role: Perform, train, and mentor Ability to: request and understand a referral order, use portals to check active eligibility through payer portal and Waystar, verify PCP on active coverage, create a referral on the payer portal, conduct a chat through the insurance portals, create a MD universal insurance form, upload and/or scan referrals into the patient account, Index referrals, fax referrals, document the account completely and appropriately, update and revise mnemonics and demographic accurately, present referral in a timely manner
• Authorization Specialist Role: Perform, train, and mentor Ability to: verify active eligibility through payer portal and Waystar, to initiate a pre-determination and/or authorization, to find procedure and/or diagnosis codes, request and/or access, and provide supporting documentation, verify and/or run medical necessity, document in the account completely and appropriately, upload and/or scan authorizations, initiate and reply professionally when engaging with provider representatives, follow through on accounts to completion, navigate within the portals, conduct a chat through the payer portals, initiate a peer to peer, appeal level I & II, 2 weeks out on service dates
• High school diploma, or GED
• 2 years minimum with preference of 4 or more years of experience with hospital, ambulatory, and/ provider practice in areas related to registration, verification of eligibility, obtaining benefits, pre-authorizations, coding, billing, patient accounting, accounts receivables, mentoring, training of patient registration, insurance registration with referrals and/or authorization documenting.

Responsibilities

• Accuracy & Quality: Consistently produces work that is detailed, accurate, organized, and of high quality.
• Demonstrates and encourages staff to commit to high standards Investigates and identifies deficiencies and provides recommendations and resolutions.
• Creates and/or revises workflows to optimize the department’s quality, productivity and support to FHMG and FHH Communication: Communicates effectively, appropriately, and professionally to all staff and patients in a credible manner
• Ability to understand and effectively communicate in both verbal and written form, in the English language Uses active listening skills while communicating when mentoring/supporting staff and patients Information Management: Utilizes technology to manage and report information in an effective and efficient manner
• Lead will provide fact base verbal, written, and electronic resources of information to make appropriate decisions with good judgment Planning & Scheduling: Organizes workflows, processes, and schedules according to the department’s standards of procedure while allowing contingencies, to ensure that the department’s continual support to FHMG and FHH
• Anticipates necessary project and workflows using forward thinking, when there are events outside of the usual standards of the department Financial responsibility: Verify and document accurate insurance eligibility, benefits, authorization requirements, and patient cost share estimates, when applicable, in a timely manner.
• Provides, when applicable, Frederick Health’s financial assistance program and contact information to the FA department.
• Assist department manager in reducing denied claims by reviewing financial spreadsheets provided by the central billing office.
• Teamwork: Contributes valuable ideas, opinions, and feedback in an open and candid manner Reliable in commitments made to others Easily adaptable to change Displays a positive work attitude and motivates others Ability to multitask throughout the day Train, assist, and mentor staff willingly and effectively with a satisfactory retention outcome
• Adhere, maintain, and optimize standards of procedures, workflows, and processes
• Learn and maintain knowledge of all service lines supported by the department
• Maintain and disseminate current Frederick Health provider listings, insurance updates, workflow updates, employee updates, staff directory, NPI/PTAN updates, referral templates
• Cover service lines and manage during staff shortages
• Ensure adequate equipment and supplies are available to staff within the department
• Contact maintenance to ensure safety and appropriate functionality of equipment and furnishings
• Attend meetings, seminars, web training courses, classes to learn and share with the staff
• Notify staff of system outages, office closures, Staff late arrivals, early leave, PTO, SSL, interim process changes and/or special projects
• Interdepartmental staff huddles
• Organize Isilonnas fax folder
• Review back-dated referrals
• Review and submit to registration and/or mnemonic errors to practice managers and trainers
• Review and advise Practice managers of FHMG PCPs entering orders for insurances that require an insurance referral, but the payer has a non FHMG PCP listed on their active insurance
• Observe and monitor call queue for adequate coverage and accountability
• Available to answer questions, make recommendations, provider resources, educate and mentor, train
• Help staff meet expectations, remain compliant of the departmental guidelines and standards, and continue to develop professional supportive comradery
• Work with trainers to develop appropriate training materials, optimize training, assist in training, prioritize training
• Provide, update/revise resources pertaining to service lines, process, workflow systems, applications, software/hardware
• Run daily, weekly, monthly staff productivity to ensure volume of work meets expectations and ensures quality work performance
• Reports to include call queue logs, workload messages and tasks, assigned worklists, completed referrals, special projects

Benefits

• Health, Dental and Vision insurance are offered the 1st of the month after 30 days of employment to all employees hired to work at least 20 hours per week and offer multiple plans to best meet you and your family needs.
• Life insurance, Short-Term Income Replacement and Long-Term Disability are employer paid for eligible employees.
• Frederick Health offers a robust Paid Time Off program for eligible employees.
• Our 403B retirement plan helps you save for your retirement and includes an employer match to eligible employees.
• All employees have access to free financial planning sessions.
• We also offer an educational assistance program to support your education goals as well as an employer paid Employee Assistance Program.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED