The Patient Access Specialist gathers necessary insurance and demographic information from patients. The Specialist translates the information provided by the patient/guarantor into the computer system with the result of an accurate claim submission. May be responsible for some or all of the following: insurance verification, prior authorization, pre-certification, referrals, second opinion management, insurance assignments and/or workers compensation authorizations.
Essential Job Functions:
Receives and directs all patients, visitors and professionals, ensuring their needs are met in a timely manner. Answers telephone, routes calls and messages and communicates messages requiring immediate action/response. Checks in patients and completes copying requests according to standard operating procedure.
Accurately registers patients by collecting and recording demographic, insurance, financial, and clinical data in the computer system. Records and collects necessary patient account documents. Collects self-pay balances, pre-payment amounts, and co-pays per guidelines, if applicable. Creates accounts for new patients and updates accounts for previous patients to ensure accurate services and account processing.
Maintains knowledge of and complies with third-party payers' requirements for verifying insurance information, obtains authorizations/pre-certifications, and completes other activities to ensure services are billed and reimbursed appropriately. Reviews Medicare accounts for completed MSPQ.
Schedules patient visits and/or procedures, while coordinating appointments with other departments to meet the patient/provider needs.
Performs other duties as assigned or needed to meet the needs of the department/organization.
Education:
• Preferred: Associates - Healthcare
Work Experience:
• Preferred: A minimum of 1 year Related Experience
