Under the direction of the Co-Op Pre-Registration and Financial Clearance Manager, the Patient Access Specialist II is responsible for pre-registration and financial clearance activities. This position is responsible for collecting and documenting required patient demographic and financial data elements for scheduled visits and completing pre-service collections. This position is also responsible for verifying patient insurance, confirming benefits eligibility, and performing authorization, pre-certification, and/or notification as required by third-party coverage providers. In addition to daily pre-registration and financial clearance functions, the Patient Access Specialist II should serve as a functional expert for department peers.
Essential Values-Based Competencies:
Demonstrates values-based competencies in line with the four core values that are the foundation of all activities performed by employees in order to achieve the Mission of the St. Joseph Health System.
Demonstrates competence in communication and interpersonal
Demonstrates competence in continuous improvement, continuous learning, accountability, and teamwork.
Demonstrates competence in customer/patient focus and adaptability.
Demonstrates competence in community orientation and stewardship.
1. Obtain/confirm and enter demographic and other financial and clinical information necessary for financial clearance of scheduled patient accounts.
2. Contact patient’s family or physician offices to obtain missing insurance information which can include policy number, group number, date of birth, and insurance phone number if patient does not have insurance cards during emergent/urgent admission.
3. Verify insurance using online electronic verification system or by contacting payor directly.
4. Confirm and document insurance eligibility of patient coverage benefits, including coverage limits, number of days, patient responsibility, effective dates, and follow-up with patient and/or referring physician office in the event of failed eligibility.
5. Collaborate with scheduling departments to identify add-on patients (patients scheduled for services less than two days from booking date).
6. Obtain authorization, pre-certification, referral, and/or notification as necessary.
7. Notify patients of their liabilities prior to date of service as determined by insurance benefits and coverage limits; collect liabilities per department guidelines.
8. Daily focus on attaining productivity standards; recommend new approaches for enhancing performance and productivity when appropriate.
9. Maintain appropriate records, files, and timely and accurate documentation in the system of record.
10. Act as a knowledgeable resource on Pre-Registration and Financial Clearance functions for department staff. (e.g., answer account questions, assist with new staff training, etc.)
1. Review own work for accuracy and completeness prior to end of shift.
2. Meet productivity and quality goals/standards.
3. Adhere to state and federal regulations.
4. Identify and alert a member of the management staff of any situation that may negatively impact the patient, department operations, public relations, or the hospital's integrity.
5. Perform other duties as assigned.
Core Position Competencies:
(Level 1: Basic, Level 2 Intermediate, Level 3: Advanced)
Demonstrated knowledge of high level revenue cycle structure, insurance payor and benefit types, and pre-registration and financial clearance functional requirements. In addition, demonstrates familiarity with ICD-9 coding, as well as medical terminology.
Familiar with hospital information systems and health plan payor websites; maintain computer and office equipment skills.
Ability to complete assigned functions and associated quality assurance within required timelines.
Ability to identify, address, and escalate issues related to financial clearance and pre-registration functions.
Communicate through both verbal and written methods of communication.
Additional Knowledge / Skills / Abilities:
1. Ability to handle cash and credit/debit card transactions, including collecting and refunding payments to patients.
2. Exceptional customer service skills.
3. Able to handle potential agitated customers, physician/clinical staff, and internal staff.
4. Ability to work in a team environment.
5. Must work independently, be self-directed, and work effectively with individuals who have a wide, diversified background.
6. Ten-key touch required.
7. Ability to type 45 WPM.
8. Effective written and verbal communication skills.
9. Knowledge of computer software programs and use of basic office equipment required.
10. Analytical and problem-solving skills required.
11. Knowledge of medical insurance and types of payor benefits.
12. Knowledge of bill codes (DRG, ICD-9, CPT and HCPCS codes).
Experience in medical management computer applications.
Minimum Position Qualifications:
High school diploma or GED preferred.
3 or more years of financial clearance and/or pre-registration experience required.
Preferred Position Qualifications:
1. 5 years pre-registration and financial clearance experience preferred.
2. Certification as a Certified Revenue Cycle Representative (CRCR) by the Healthcare Financial Management Association (HFMA), or related certification preferred.
3. Bilingual English/Spanish.
St. Joseph Health (SJH) is an integrated healthcare delivery system sponsored by the St. Joseph Health Ministry and organized into three regions: Northern California, Southern California, West Texas/Eastern New Mexico.
SJH provides a full range of care from facilities including 14 acute care hospitals, home health agencies, hospice care, outpatient services, skilled nursing facilities, community clinics, and physician organizations. SJH maintains a 'continuum of care,' matched to the diverse needs of the urban centers, smaller cities and rural communities in three states. For the third year in a row in 2009, the Gallup Organization awarded St. Joseph Health its highest honor - the Great Workplace Award. SJH provides exceptional benefits, opportunities for advancement and relocation within the system.
St. Joseph Health is comprised of four core values: Service, Excellence, Dignity, and Justice are the guiding principles of all we do.
Excellent compensation program and benefits provided. SJH is an EEO/AA Employer.
3345 Michelson Drive
3345 Michelson Drive
St. Joseph Health
- 2 years ago - save job