Patient Access Specialist II

UPMC•Pittsburgh, PA

About The Position

Typically, functions under the direction of the Supervisor/Manager responsible for patient access. Schedule appointments for different departments, specialties, subspecialties and/or large divisions at multiple locations or centers. Serve as front line resource for PSD Departments to manage access of external public to our care providers and ensures goals of 72 hours patient access are met while making the appropriate appointment with the right sub specialist at the right location so the patient needs are met with the first visit whenever possible.

Requirements

Completion of high school diploma or equivalent and 2 years of medical office, customer service, inbound call center (preferred) or other relevant health care experience required.
Must have working knowledge of Word and Outlook.
Initiative to work productively in a team setting with minimal supervision.
Must be able to multitask at a high level.
Must be able to learn new concepts quickly and apply them in a medical setting.
Must be able to maintain confidential information.
Ability to interact with a variety of external and internal constituents, including patients, patients' families, internal physicians, referring physicians or their clinical/office staff, insurance companies, nurses.
Must be able to make appropriate decisions based on the circumstances as well as established protocols.
Must be able to learn and apply third party payer guidelines and reimbursement practices and available financial resources for the funding of medical care.
Must have strong interpersonal, organizational, and communication skills and be able to remain professional and courteous when dealing with sensitive issues and stressful circumstances.
Must demonstrate the ability to effectively problem solve and make independent decisions.

Nice To Haves

Associates degree and 1 year of medical office, customer service, inbound call center (preferred) or other relevant health care experience preferred.
Working knowledge of Excel is preferred.
Advanced knowledge of health insurance preferred.
Experience with/knowledge of medical terminology and multi-line telephone systems is preferred.
Electronic scheduling system experience is preferred.

Responsibilities

Make decisions independently and take initiative to find answers to questions.
Appropriately triage phone calls to or from clinical and other areas.
Ensure effective communication and call escalation to appropriate personnel; includes thorough and accurate documentation of telephone encounter.
Research, resolve and respond to email, web and telephone billing inquiries from patients and insurance carriers in accordance with departmental protocols.
Maintain performance at or above established benchmarks for: Quality Assurance. Average Call Handling Time, Schedule Adherence and Telephone Aux usage.
Demonstrate the ability to understand the reason for a consumer referral call. Use decision making ability to appropriately refer a physician, class or program to meet the consumer's needs.
Ensure effective communication to patients regarding scheduling and call details, give basic information to patients (directions, parking information, and required preparation for appointment).
Demonstrate the ability to understand the reason/needs for the patient or clinicians call and apply the decision making ability to page or contact the appropriate physician to meet the patient's needs.
Review, verify and enter the patient's demographic and insurance information to ensure data integrity.
Demonstrate ability to understand reason for patient visit and apply decision making ability to schedule an appointment with the correct sub-specialist by obtaining medical information/diagnosis in order to adequately meet the patient's needs and allow for appropriate scheduling to a specific physician or specialty.
Answer multi-line telephone system and schedule appointments, contact or page physicians according to department questionnaires, protocols and templates.
Provide support to supervisor/manager in the instruction of training new staff in order to maintain a high quality of service to the patient and the department.
Understand UPMC 72-hour appointment requirement and work to ensure guidelines are met while still placing the patient with the right sub-specialist whenever possible to avoid return visit to see the correct sub-specialist.