Patient Access Resource Specialist - Enterprise Scheduling

SUMMARY:

Assists with coordination of daily operations for scheduling, pre-registration/verification, insurance benefits, and admissions. Engages in training for all new hires and ongoing process changes for the assigned department.  Provides employee feedback as needed.

ESSENTIAL FUNCTIONS:

Provides routine daily internal interface with unit/department management and staff, other access service areas, information systems, physicians, and physicians’ office staff.

Provides external service to patients, physicians, software/hardware vendors, and third party payers. 

Assists staff with problem solving, routine questions, and customer interaction to ensure positive results.

Ensures notification of ancillary departments, other access areas and patients, within schedule guidelines, of changes or cancellations by regulatory agencies and third party payers with respect to authorizations, and verification requirements.  

Maintains current knowledge of the outpatient scheduling criteria/processes for each ancillary department to ensure correct procedures are scheduled by staff.

Oversees the process of notification to the Financial Counselors when intervention is indicated for potential uncompensated care.

Schedules procedures, participates in pre-registration and financial verifications, obtains insurance benefits, and complete admissions of patients when necessary to ensure the smooth flow of the unit.

Ensures the timely processing of all physician orders, pre-registration, verification of insurance eligibility, benefits, prior authorizations, and medical necessity screening is completed prior to services being rendered.

Interprets and explains to patients and their families’ charges, services, and hospital policy regarding payment of bills in accordance with TMC HealthCare Credit and Collection policies.

Builds and maintains communication alliances with support and related personnel in the IS department, ancillary departments, nursing units and other financial service personnel.

Evaluates, learns and assists in the implementation of new software programs/systems, and other related technologies.

Communicates information to the Supervisor and/or Manager as needed to ensure a smooth and seamless access process prevails in each registration area.

Exhibits excellence in customer service through appropriate attitude and interaction with all patients, visitors and staff.

Adheres to and supports team members in exhibiting TMCH values of integrity, community, compassion, and dedication. 

Adheres to TMCH organizational and department-specific safety and confidentiality policies and standards.

Performs related duties as assigned.

MINIMUM QUALIFICATIONS

EDUCATION:    High school diploma or General Education Degree (GED), or an equivalent combination of relevant education and experience.

EXPERIENCE:   Four (4) years of medical insurance, billing and/or scheduling experience; preferably has served as lead over other revenue cycle staff.

LICENSURE OR CERTIFICATION:  None required. Certified Healthcare Access Associate (CHAA) certification or proficiency testing strongly preferred.

KNOWLEDGE, SKILLS AND ABILITIES: 

• Knowledge of hospital billing, insurance and scheduling processes and procedures.

• Skilled in the use of computer applications such as: Excel, Word, Internet, e-mail, and terminal emulator programs; maintains basic knowledge of networked computer systems.

• Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.

• Possesses and maintains knowledge of current regulatory and third party payer changes with respect to authorizations, verification requirements to support billing reimbursement.

• Ability to write reports, business correspondence, and procedure manuals.

• Ability to effectively present information and respond to inquiries or complaints from employees, patients, and/or their representatives, and the general public.

• Ability to calculate figures and compute rate, ratio, and percent and to draw and interpret bar graphs; ability to apply basic algebraic concepts.

• Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.

• Ability to deal with problems involving several concrete variables in standardized situations.