Patient Access Specialist

Lake Charles Memorial Health System; Lake Charles (LA); On-site; USD 36,000 - 52,000; Full time

Job summary

Lake Charles Memorial Health System in Lake Charles, LA seeks a Patient Access Specialist to perform administrative duties including referrals, provider scheduling, precertifications for procedures, and related processing for all patients in the EMR system.

The role requires knowledge of CPT coding, medical necessity review, and strong insurance processing. The incumbent will greet patients, verify information, and maintain accurate EMR records, with teamwork and communication essential.

Qualifications

• Knowledge of CPT coding and Medical Necessity of testing.
• Greets each patient warmly and cheerfully.
• Knowledgeable about insurance processing and able to explain deductibles, co-insurance, co-payments, and how processing occurs.
• Answers phone with correct salutation. Takes messages when appropriate.
• Records all messages into electronic EMR.
• Verifies patient information, demographics and insurance coverage is correct.

Responsibilities

• Greets each patient warmly and cheerfully.
• Explain deductibles, co-insurance, and co-payments; insurance processing.
• Answers phone with correct salutation and takes messages.
• Verifies patient information and updates EMR.
• Schedules testing after precertification per physician checkout orders.
• Completes referrals through the EMR following correct protocol.

Skills

CPT coding

Medical Necessity

Insurance processing

Patient communication

EMR navigation

Education

High school diploma or equivalent

Medical terminology knowledge

Keyboarding skills

Computer skills

Tools

EMR system

Microsoft Office

Job description

• The patient access specialist performs administrative duties including, but not limited to: referrals, maintain provider schedules, prior authorizations for procedures/tests/medications, schedule outside procedures/testing, and performs related processing duties for all patients being served by respective clinic. Duties are performed in the EMR system as appropriate. The patient access specialist is trained in performing a wide range of skilled administrative and clerical duties.

SUPERVISION: Reports directly to Practice Manager

RESPONSIBILITIES AND DUTIES:

• Knowledge of CPT coding and Medical Necessity of testing. Ensures criteria met prior to scheduling testing and/or procedures, including surgery.
• Greets each patient warmly and cheerfully.
• Knowledgeable about insurance processing and able to explain deductibles, co-insurance, co-payments, and how processing occurs.
• Answers phone with correct salutation. Takes messages when appropriate.
• Records all messages into electronic EMR.
• Verifies patient information, demographics and insurance coverage is correct. If changes are required, changes the information in the EMR.
• Updates and scans updated information and forms into appropriate EMR system.
• Scan and attach all paperwork received into EMR system and attach and send appropriately.
• Schedules all testing after obtaining precertification per physician checkout orders.
• Completes and sends medical records request per physician orders.
• Completes all referrals through the EMR following correct protocol.
• Verification of insurance should be performed when necessary.
• Performs other job duties as assigned.

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.

EDUCATION AND WORK EXPERIENCE

• High school diploma or equivalent required.
• Knowledge and training in medical terminology, keyboarding, and computer skills preferred.
• Basic skills in Microsoft Office preferred.
• Previous experience preferred in the areas of scheduling.
• Broad range of administrative and technical skills in the context of the healthcare environment.
• Impacts activities in other work areas on a frequent basis and contributes in multiple work areas.
• Make decisions based on departmental policy.
• Demonstrates critical thought process and can work independently.
• Provides feedback to assist with decision making process.
• Works well with others.
• Documents detailed information in patient chart.
• Requires listening skills to maintain cooperative associations.

Physical Demands/Work Environment

• Work requires a variety of physical activities, including moving about within and outside of all hospital properties for long periods of time.
• Must be able to respond quickly and effectively to emergency and non-emergent situations.
• May be required to assist in controlling disorderly conduct or combative patients.
• Must be able to exchange accurate information with patient, family, peers and medical personnel.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

“Experience Memorial” is more than a slogan, it’s the care we provide our patients and it’s the commitment to our community and our team members. As a nationally certified Great Place to Work, at Lake Charles Memorial Health System you will have the opportunity to be a part of an organizational culture that supports not only exceptional patient care but also the well-being and professional growth of our employees. Join us and be a part of a team where your contributions are valued, your growth is nurtured, and your success is celebrated.