Patient Access Specialist - Insurance (Full Time)

Lake Charles Memorial Hospital•Lake Charles, LA

About The Position

DESCRIPTION OF POSITION: Under the direction of the Patient Access Supervisor this employee is responsible for promoting a caring and compassionate environment that allows Lake Charles Memorial Hospital to provide an individualized experience to our patients. This employee is devoted to promoting excellent patient and provider relations that encourage a lasting connection. This position gives our patients the access to the care they need by ensuring all scheduled and unscheduled procedures have been authorized by the payer. As well as providing a patient estimate prior to services, when possible, to ensure point of service collections are completed in accordance with established departmental policies and procedures. SUPERVISION: Reports directly to the Patient Access Supervisor RESPONSIBILITIES AND DUTIES: Employee is knowledgeable of the LCMH Financial Assistance program and is well versed and able to give a clear definition of the program to all customers. Employee is able to recognize when someone may need assistance and offers assistance without hesitation. Employee provides application and provides details as to what information will be needed to process a complete application. Quantifies applicable patient portions on each patient and discuss financial obligations. Is able to comfortable negotiate with the patient to meet their needs as well as their obligations. Employee completes patient estimates. Employee is knowledgeable of CPT and procedure codes and is able to accurately complete estimates. Uses EPIC RTE on all applicable patients and only excludes those that have Medicaid, Medicare and a secondary insurance, and those patients who qualify for full coverage under financial assistance. Employee strives to meet cash collection goals. Employee is knowledgeable about insurance processing and is able to explain deductibles, co-insurance, co-payments and how processing occurs. Employee clearly documents all actions on accounts to ensure the success of any employee who touches the account in any manner. Employee documents the name of the insurance company, phone number(s), website, and reference numbers given. Employee also scans appropriate documentation to the patients account for future reference. Employee pays close attention to detail ensure that any pre-existing periods, policy riders, or low coverage policies are addressed prior to the procedure or notifies financial counseling when patients are admitted as an emergent patient. Employee completes all scheduled accounts within a timely manner not to exceed 5 days prior to the scheduled date. Employee notifies physicians office staff of authorization requirements timely to ensure authorization can be obtained 3 days prior to the procedure. Employee provides notification to management when an account has reached 3 days out and does not have an authorization so that management can assist if possible. Also keeps management up to date daily until the day prior to the procedure so that a discretionary decision can be made regarding the procedure being postponed. Employee meets acceptable productivity standards working a minimum of 55 accounts per day. Employee verifies benefits are active and quantifies patients benefit levels including but not limited to: Deductibles, co-insurance, co-payments, life-time maximum, yearly out of pocket, pre-existing, policy riders, and non-covered services. Employee submits timely notification to all insurance companies of patients that have been admitted to the facility in order to meet notification requirements. Verifies correct patient type versus orders, ensures order has a status listed. When a status is not listed employee will follow up with the physicians office to obtain a corrected order. The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.

Requirements

High School graduate or GED certificate.
Basic office and keyboarding skills and the ability to use computer, printer, fax machine, scanner and calculator.
Basic math skills for collection and reconciliation purposes.
Proficient skills and understanding of Word and Excel.
Ability to use multiple databases and hospital specific software.
Interpersonal skills to interact effectively with patients from various backgrounds in a professional, enthusiastic, courteous and caring manner.
Appropriate phone etiquette.
Complete understanding of time of service collections and collection goals.
Basic knowledge of medical terminology and insurance/managed care program regulations.
Ability to read, write and speak intelligible English
Ability to communicate with patients, family, peers and medical personnel
Basic math skills and appropriate phone etiquette.
Requires emotional stability and resilience
Must be adaptable to change, be decisive, and demonstrates foresight
Exhibits organizational and leadership ability.

Nice To Haves

Previous work experience in healthcare or medical insurance environment preferred.

Responsibilities

Knowledgeable of the LCMH Financial Assistance program and is well versed and able to give a clear definition of the program to all customers.
Recognize when someone may need assistance and offers assistance without hesitation.
Provide application and provides details as to what information will be needed to process a complete application.
Quantifies applicable patient portions on each patient and discuss financial obligations.
Comfortably negotiate with the patient to meet their needs as well as their obligations.
Complete patient estimates.
Knowledgeable of CPT and procedure codes and is able to accurately complete estimates.
Uses EPIC RTE on all applicable patients and only excludes those that have Medicaid, Medicare and a secondary insurance, and those patients who qualify for full coverage under financial assistance.
Strive to meet cash collection goals.
Knowledgeable about insurance processing and is able to explain deductibles, co-insurance, co-payments and how processing occurs.
Clearly documents all actions on accounts to ensure the success of any employee who touches the account in any manner.
Documents the name of the insurance company, phone number(s), website, and reference numbers given.
Scans appropriate documentation to the patients account for future reference.
Pay close attention to detail ensure that any pre-existing periods, policy riders, or low coverage policies are addressed prior to the procedure or notifies financial counseling when patients are admitted as an emergent patient.
Complete all scheduled accounts within a timely manner not to exceed 5 days prior to the scheduled date.
Notify physicians office staff of authorization requirements timely to ensure authorization can be obtained 3 days prior to the procedure.
Provide notification to management when an account has reached 3 days out and does not have an authorization so that management can assist if possible.
Keeps management up to date daily until the day prior to the procedure so that a discretionary decision can be made regarding the procedure being postponed.
Meet acceptable productivity standards working a minimum of 55 accounts per day.
Verify benefits are active and quantifies patients benefit levels including but not limited to: Deductibles, co-insurance, co-payments, life-time maximum, yearly out of pocket, pre-existing, policy riders, and non-covered services.
Submit timely notification to all insurance companies of patients that have been admitted to the facility in order to meet notification requirements.
Verifies correct patient type versus orders, ensures order has a status listed.
Follow up with the physicians office to obtain a corrected order when a status is not listed.