Patient Access Specialist - Full Time - Days

Jupiter Medical Center • Essex, VT

2d • Onsite

About The Position

The Patient Access Specialist will be responsible for delivering a dynamic customer experience to all customers and demonstrate a strong commitment to service excellence. The Patient Access Specialist is responsible for obtaining demographic, insurance, and medical information to ensure an accurate and complete registration. Performing insurance verification, data collection and documentation. Determine medical necessity for services based on established medical criteria. Identifying patient financial responsibilities and collecting applicable monies. Acting as liaison to all internal and external customers to facilitate access to hospital services. Secures all necessary documentation to register the patient's visit. Reviews all documentation to ensure coding by provider is supported and accurate. Applies all coding rules and use of CPT and ICD 10 codes and appropriate use of modifiers. Assist manager in educating physicians and staff in requirements of documentation for proper reimbursement. Assists in conducting internal audits of patient charges and corresponding documentation, reports, and tracks on a monthly basis. Submit claims and works rejections for claims submission, daily. Checks for data errors and uses them as examples for educating team members. Determines problems that resulted in a rejected claim, resolve, advises on procedural changes to implement, and prevent further such rejects. Resubmits/refiles, print records as needed to appeal rejected claims, as is necessary. Check coding and post charges. Adhere to contractual requirements of Medicare, Medicaid, and managed care plans. Scrubs and reviews charges before claims are submitted. Reviews surgical claims and post-op visits to ensure we capture a full reimbursement. Run daily update and insurance exception reports. Review and correct, re-scrub rejected claims. Performs other duties as assigned.

Requirements

• High School Graduate or Equivalent
• BLS certification through the American Heart Association for Healthcare Providers
• Experience required in using EMR systems, insurance verification, eligibility, and electronic billing.
• Requires general and specific knowledge of health insurance plans and interpretation of health insurance benefits.
• Ability to maintain confidentiality.
• Experience in a customer support role.
• Medical terminology knowledge.
• Proficient skills in computer applications such as Microsoft Office.
• Ability to set priorities and manage time effectively.
• Exceptional communication skills both verbally and in writing.
• Superior organizational skills, attention to detail, and able to multi-task.
• Strong interpersonal skills, listening and ability to carefully follow directions.
• Annual Joint Commission mandatory education requirements, in-service and health requirements including attendance at new employee orientation, TB/PPD Surveillance Program and Maintenance of required professional licensing and/or certification(s).

Nice To Haves

• Billing and Coding Certification preferred

Responsibilities

• Delivering a dynamic customer experience to all customers and demonstrate a strong commitment to service excellence.
• Obtaining demographic, insurance, and medical information to ensure an accurate and complete registration.
• Performing insurance verification, data collection and documentation.
• Determining medical necessity for services based on established medical criteria.
• Identifying patient financial responsibilities and collecting applicable monies.
• Acting as liaison to all internal and external customers to facilitate access to hospital services.
• Securing all necessary documentation to register the patient's visit.
• Reviewing all documentation to ensure coding by provider is supported and accurate.
• Applying all coding rules and use of CPT and ICD 10 codes and appropriate use of modifiers.
• Assisting manager in educating physicians and staff in requirements of documentation for proper reimbursement.
• Conducting internal audits of patient charges and corresponding documentation, reports, and tracks on a monthly basis.
• Submitting claims and working rejections for claims submission, daily.
• Checking for data errors and using them as examples for educating team members.
• Determining problems that resulted in a rejected claim, resolving them, advising on procedural changes to implement, and preventing further such rejects.
• Resubmitting/refiling, printing records as needed to appeal rejected claims, as is necessary.
• Checking coding and posting charges.
• Adhering to contractual requirements of Medicare, Medicaid, and managed care plans.
• Scrubbing and reviewing charges before claims are submitted.
• Reviewing surgical claims and post-op visits to ensure full reimbursement is captured.
• Running daily update and insurance exception reports.
• Reviewing and correcting, re-scrubbing rejected claims.
• Performing other duties as assigned.

Benefits

• Continued success depends on it!
• Our team is expanding, and we want to hire the most talented people we can.
• Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful.
• They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.

What This Job Offers

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