Patient Access Specialist – Referrals and Authorizations

Patient Access Specialist – Referrals and Authorizations

Requirements

• High School Graduate or Equivalent
• Billing and Coding Certification preferred
• Experience required in using EMR systems
• Experience in insurance verification, eligibility, and electronic billing
• General and specific knowledge of health insurance plans and interpretation of health insurance benefits
• Extensive knowledge of current billing and coding rules and regulations
• Use of CPT & ICD 10 codes including appropriate modifiers for Radiation Oncology, Infusion and Oncology Surgery
• Ability to read, understand, and adhere to CMS & NCCN guidelines and compliance
• 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
• Flexible, service oriented, and dedicated
• 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

Responsibilities

• Deliver a dynamic customer experience to all customers
• Obtain demographic, insurance, and medical information for accurate registration
• Perform insurance verification, data collection, and documentation
• Determine medical necessity for services based on established medical criteria
• Identify patient financial responsibilities and collect applicable monies
• Act as liaison to all internal and external customers to facilitate access to hospital services
• Secure all necessary documentation to register the patient’s visit
• Review all documentation to ensure coding by provider is supported and accurate
• Apply 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
• Assist in conducting internal audits of patient charges and corresponding documentation, reports, and tracks on a monthly basis
• Submit claims and work rejections for claims submission, daily
• Check for data errors and use them as examples for educating team members
• Determine problems that resulted in a rejected claim, resolve, advise on procedural changes to implement, and prevent further such rejects
• Resubmit/refile, 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
• Scrub and review charges before claims are submitted
• Review surgical claims and post-op visits to ensure full reimbursement
• Run daily update and insurance exception reports
• Review and correct, re-scrub rejected claims
• Perform other duties as assigned

Preferred Qualifications

• Billing and Coding Certification preferred