Patient Access Services Specialist - Inpatient Admitting
Serves as first point of contact for customers of TMC Healthcare; evaluates and reconciles authorizations for specialized outpatient diagnostic TIA (Transient Ischemic Attack), ECT (electroencephalogram) services or as requested, Inpatient Gero-psych and Hospice admissions ensuring contracted payor’s remit to TMC Healthcare scheduled services. Maintains high level working knowledge of specific stipulations for authorizations within each benefit structure.
Adheres to and supports team members in exhibiting TMCH values of integrity, community, compassion, and dedication.
Evaluates authorization requirements for outpatient diagnostic scheduled services (TIA/ECT’s) and admissions comparing to payor websites and updates payor matrix for specified services.
Collects deposits or deductibles and advises patient or guarantor of insurance benefits and anticipated cost estimates; ensures that cash handling follows corporate policies.
Explains all necessary compliance forms and obtains patient signature as required for regulatory agencies
Interacts with physicians and/or physicians’ office staff to secure diagnosis, procedure details or authorizations and information for denials as needed.
Uses medical terminology and scheduling knowledge to select correct procedure when scheduling and coordinates information with other departments as needed.
Performs patient registration activities to ensure accurate financial and biographical data and documentation have been obtained and properly entered into hospital records.
Completes insurance processing; including account creation, insurance verification, notification, and authorization functions, follow ups on denials and no response claims.
Communicates with departments/physicians for special requests, emergent cases, overbooking and add-ons; informs management about issues/problems with tools/times.
Adheres to TMCH organizational and department-specific safety and confidentiality policies and standards.
Reconciles daily cash drawer.
Performs related duties as assigned.
EDUCATION: High School diploma or General Education Degree (GED), or an equivalent combination of relevant education and training.
EXPERIENCE: Three (3) years of medical office and/or hospital experience to include six months healthcare eligibility and benefit analysis or scheduling experience for diagnostic testing and/or surgery. Applicants must have basic computer familiarity and experience.
LICENSURE OR CERTIFICATION: None required.
KNOWLEDGE, SKILLS AND ABILITIES:
Knowledge of healthcare billing, scheduling and insurance policies and practices.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.Ability to make independent decisions based on guidelines.
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
Ability to complete routine reports and correspondence.
Ability to listen and accurately interpret others’ communication or instructions to take appropriate action.
Ability to speak effectively before groups of customers or employees of the organization.
Ability to calculate figures and compute rate, ratio, and percent and to draw and interpret bar graphs; ability to apply basic algebraic concepts.