Specialist Pre Access

SEH Saint Elizabeth Medical Center, Inc.; Erlanger (KY); On-site; USD 22,000 - 33,000; Full time

Job summary

St. Elizabeth Healthcare is seeking a Pre-Access Specialist to secure patient accounts from initial contact through examination, coordinating scheduling, pre-registration, verification and pre-collection processes.

In this role you will help ensure accuracy, payer compliance and a positive patient experience by following standard protocols, gathering necessary clinical and demographic information, and communicating with referring offices and departments.

Qualifications

• Strong customer service skills reflecting mission and values.
• Ability to obtain accurate patient demographic and insurance information.

Responsibilities

• Schedules and/or pre-registers OP procedures/appointments from physician offices, patients, or other departments via telephone inquiry, fax request or WQ.
• Obtains patient demographic, insurance and clinical information to ensure appointments are complete and accurate.
• Maintains good public relations to ensure a positive impression.
• Performs pre-authorization and verification for specified procedures with payer.
• Communicates schedule discrepancies with appropriate department.

Job description

Engage with us for your next career opportunity. Right Here. Job Type: Regular Scheduled Hours: 40

Why You'll Love Working with St. Elizabeth Healthcare

At St. Elizabeth Healthcare, every role supports our mission to provide comprehensive and compassionate care to the communities we serve. For more than 160 years, St. Elizabeth Healthcare has been a trusted provider of quality care across Kentucky, Indiana, and Ohio. We're guided by our mission to improve the health of the communities we serve and by our values of excellence, integrity, compassion, and teamwork. Our associates are the heart of everything we do.

Benefits That Support You

We invest in you - personally and professionally. Enjoy:

• Competitive pay and comprehensive health coverage within the first 30 days.
• Generous paid time off and flexible work schedules
• Retirement savings with employer match
• Tuition reimbursement and professional development opportunities
• Wellness, mental health, and recognition programs
• Career advancement through mentorship and internal mobility

Job Summary

Demonstrate respect, dignity, kindness and empathy in each encounter with all patients, families, visitors and other employees regardless of cultural background. The Pre-Access Specialist is a system-wide position responsible for securing a patient account from the initial interaction through the performed exam. They are responsible for the scheduling, pre-registering, verification, authorization and pre collection process. This position exists to enhance customer service, while securing accounts according to standard protocols and payer requirements.

Job Description

• Schedules and/or pre-registers OP procedures/appointments from physician’s offices, patients, or other ancillary departments via telephone inquiry, fax request or CPOE WQ.
• Obtains appropriate patient demographic, insurance information and clinical information to ensure that appointments are complete and accurate.
• Understands the proper use of the scheduling software.
• Maintains good public relations skills to ensure a positive impression.
• Conducts appointment triage at the time of scheduling to ensure the needs of patients and each clinical specialty are met.
• Provides accurate and complete patient exam preparation instructions.
• Avoids testing conflict with other scheduled exams in accordance with standard protocols.
• Offers scheduling flexibility between all Units and considers patient convenience when making appointments.
• Stays within individual departmental guidelines when scheduling daily patient caseload.
• Performs "One Call" pre-registration process if speaking directly with the patient.
• Utilizes automated dialer for Pre-Registration process.
• Review incoming fax orders in Trace and indexes accordingly.
• Completes verification, benefit analysis, and authorization for specified OP procedures/appointments directly with the insurance payer.
• Communicate schedule discrepancies with appropriate department.
• Obtains accurate clinical history for appropriate pre-authorized requests.
• Provide necessary clinical information and pertinent demographic information to insurance company either via web or phone call.
• Requires knowledge of appropriate CPT for each procedure.
• Communicate with referring office or hospital department when a discrepancy arises with procedure scheduled.
• Document appropriate authorization number and valid dates for each procedure.
• Begin work on all pre authorizations scheduled out 30 days.
• Communicates payer requirement changes to the pre access lead or management staff.
• Monitor insurance company protocols for authorization changes.
• Work in conjunction with Marketing and SEP Management to provide resources needed for referring office education.
• Perform eligibility and benefit analysis for all admissions, surgeries, and observation services.
• Obtain authorization as needed from referring physician office and verify for accuracy.
• Follow individual payer matrix to ensure compliance with daily workflow process.
• Use assigned online eligibility software for payer verification and notification.
• Use TRACE tools as needed.
• Update as needed in registration following all standard registration policies and procedures.
• Work with other departments and outside entities to establish a positive working relationship that promotes cooperation and teamwork.
• Communicate with Quality Management on a daily basis to ensure the appropriateness of accounts requiring precertification and follow-up by UM personnel.
• Work closely with the financial counseling unit, including any vendors, in the sharing of account information to minimize potential denials and aid in the financial assistance process.
• Maintain a communication network with physicians’ offices, internal departments and payers to help obtain needed information and resolve problem accounts.
• Work with PFS and Revenue Cycle departments to complete retro authorization request.
• Provide support and assistance with claims denial due to pre-authorized issues.
• Completes point of service collection process as identified.
• Documents accounts appropriately.
• Adheres to Point of Service Collection policy.
• Uses strong customer service skills that reflect Mission, Vision, and Values statement of the St. Elizabeth Healthcare.
• Maintain strict patient confidentiality at all times.
• Promotes cooperation and teamwork.
• Spe