Patient Access Representative

Uconn Health Center; Farmington (CT); On-site; USD 52,000 - 75,000; Full time

Job summary

UConn Health Center in Farmington, CT, seeks an experienced payer enrollment/authorization specialist to manage insurance referrals and pre-certifications for scheduled admissions and procedures. You will coordinate with physicians and insurers to secure authorizations and verify benefits.

Responsibilities include interviewing patients, communicating with care teams, and documenting activities in the system.

Qualifications

• Knowledge of managed care, reimbursement, and health care policies.
• Basic knowledge of medical coding and medical terminology.
• Ability to articulate information clearly to patients, families, insurers, staff.
• Strong organizational and record-keeping skills.
• Ability to gather and record information for accurate billing and collections.
• Understanding of Medicare/Medicaid and commercial insurance regulations.
• Three years of experience in medical pre-authorization, insurance verification or medical claims.
• Substitution: Associate's degree and one year of experience may be substituted for general experience.
• EPIC system experience; prior authorizations for physician-administered medications preferred.

Responsibilities

• Obtain referrals and prior authorization from insurance prior to date of service.
• Communicate with physicians and providers for clinical clarifications.
• Interview patients to determine payment sources and arrangements.
• Verify patient benefits with insurers.
• Refer uninsured/underinsured patients to financial counselors.
• Assist in the appeals process for denied claims.
• Document daily activities in the computer system.
• Communicate with departments regarding authorization status.
• Research requests for patient information and prepare reports.
• Maintain records and may perform receptionist/triage duties.

Skills

Managed care knowledge

Medical coding

Communication skills

Organizational skills

Billing/collections understanding

Member/patient interaction

Education

Associate's degree in healthcare administration

Tools

EPIC system

Job description

UConn Health is a vibrant, integrated academic medical center that is entering an era of unprecedented growth in all three areas of its mission: academics, research, and clinical care. A commitment to human health and well-being has been of utmost importance to UConn Health since the founding of the University of Connecticut schools of Medicine and Dental Medicine in 1961. Based on a strong foundation of groundbreaking research, first-rate education, and quality clinical care, we have expanded our medical missions over the decades. In just over 50 years, UConn Health has evolved to encompass more research endeavors, to provide more ways to access our superior care, and to innovate both practical medicine and our methods of educating the practitioners of tomorrow.

At the UCHC, this class is accountable for performing a full range of tasks in obtaining insurance referrals from physician's offices and insurance companies and initiating follow-up on required pre-certifications for scheduled admissions and procedures in coordination with those offices.

SUPERVISION RECEIVED

Works under the general supervision of an employee of a higher grade.

SUPERVISION EXERCISED

May lead/supervise lower level employees as assigned.

EXAMPLES OF DUTIES

• Utilizing knowledge of ICD-9, CPT coding and medical terminology.
• Obtains required referral/prior authorization from insurance companies prior to date of service.
• Communicates with physician and medical providers regarding clinical clarifications to facilitate requests.
• Interviews patient via visits or phone to determine payment sources and payment arrangements.
• Verifies patient's benefits with insurance companies as needed.
• Refers uninsured and underinsured patients to financial counselors as identified.
• Assists in the appeals process for denied claims.
• Documents daily activities in the computer system.
• Communicates with departments regarding authorization status.
• Researches requests for patient information and prepares reports and correspondence.
• Maintains records and files may perform receptionist/triage duties.
• Performs related duties as required.

MINIMUM QUALIFICATIONS REQUIRED

KNOWLEDGE, SKILLS AND ABILITIES

• Working knowledge of a managed care environment, third party reimbursement, hospital and community services and hospital and health care policies.
• Basic knowledge of medical coding and medical terminology.
• Skill in articulating information in a clear and informative manner to patients, family members, insurers, staff and other relevant parties.
• Organizational skills.
• Ability to gather and record all appropriate information that provides for the accurate billing and collection for provided services.
• Ability to interpret basic Medicare/Medicaid, and commercial insurance industry regulations.

EXPERIENCE AND TRAINING

GENERAL EXPERIENCE

• Three (3) years of experience processing medical pre-authorization, insurance verification and/or medical claims for healthcare services.

SUBSTITUTIONS ALLOWED

• Associate's degree and one (1) year of the experience as listed above may be substituted for the general experience.

PEFERRED QUALIFICAIONS

• EPIC system experience.
• Experience completing prior authorizations for physician administered medications.

SCHEDULE: Full-time, 40 hours per week, Monday through Friday from 8:30 am to 5:00 pm.

The University of Connecticut Health Center is an affirmative action employer, in addition to an EEO and M/F/V/PWD/PV employer.

All employees are subject to adherence to the State Code of Ethics which may be found at www.ethics.state.ct.us .