Specialist Pre Access

St. Elizabeth Healthcare•Erlanger, KY

About The Position

The Pre-Access Specialist is a system-wide position responsible for securing patient accounts from the initial interaction through the performed exam. The role schedules and pre-registers patients, verifies eligibility and benefits, obtains authorizations, and completes pre-collection activities. The position supports customer service while securing accounts according to standard protocols and payer requirements. The specialist works with patients, referring offices, internal departments, insurers, and other entities to promote accurate account processing, cooperation, and teamwork, while maintaining patient confidentiality and reflecting St. Elizabeth Healthcare’s mission, vision, and values.

Requirements

High school diploma or GED.
One year of experience in a call center, office, healthcare, or other team-oriented setting.
PC skills, including Microsoft Word and Excel.
Strong interpersonal, organizational, and prioritization skills.
Proven excellent customer service skills.
Good typing and data-entry skills.
Excellent written and verbal communication skills.
Ability to maintain patient confidentiality.

Responsibilities

Schedule and/or pre-register outpatient procedures and appointments from physician offices, patients, or ancillary departments through telephone inquiries, fax requests, or CPOE work queues.
Obtain accurate patient demographic, insurance, and clinical information to ensure appointments are complete and accurate.
Use scheduling software appropriately and maintain positive public relations.
Triage appointments at scheduling to meet patient and clinical specialty needs, provide complete exam preparation instructions, avoid conflicts with other exams, and consider patient convenience and scheduling flexibility.
Stay within departmental guidelines when scheduling the daily patient caseload.
Perform the One Call pre-registration process when speaking directly with patients and use the automated dialer for pre-registration.
Review incoming fax orders in Trace and index them appropriately.
Complete verification, benefit analysis, and authorization for specified outpatient procedures and appointments directly with insurance payers.
Communicate schedule discrepancies with the appropriate department and resolve procedure discrepancies with referring offices or hospital departments.
Obtain accurate clinical history and provide necessary clinical and demographic information to insurers via web or phone for pre-authorization requests.
Document authorization numbers and valid dates, begin pre-authorization work for procedures scheduled 30 days out, and monitor payer protocols and requirement changes.
Communicate payer requirement changes to the pre-access lead or management staff.
Work with Marketing and SEP Management to provide resources for referring office education.
Perform eligibility and benefit analysis for admissions, surgeries, and observation services; obtain authorization as needed and verify its accuracy.
Follow payer matrices and daily workflow processes, use assigned online eligibility software, use Trace tools as needed, and update registrations according to standard policies and procedures.
Work with other departments and outside entities to establish positive working relationships and promote cooperation and teamwork.
Communicate daily with Quality Management regarding accounts requiring precertification and follow-up by utilization management personnel.
Work with financial counseling units and vendors to share account information, minimize potential denials, and support financial assistance processes.
Maintain communication with physician offices, internal departments, and payers to obtain information and resolve problem accounts.
Work with PFS and Revenue Cycle departments on retroactive authorization requests and support claims denial issues related to pre-authorization.
Complete point-of-service collection activities as identified, document accounts appropriately, and follow the Point of Service Collection policy.
Maintain patient confidentiality and demonstrate courteous, clear communication, careful listening, and strong customer service.
Interact with managers, coworkers, and hospital personnel to share work-related objectives and clarify or improve processes.
Participate in continuous quality improvement, attend required meetings and webinars, complete annual hospital and department education, follow policies and procedures, and perform other duties as assigned.