PATIENT ACCESS SPECIALIST at Aultman Health Foundation – CANTON, Ohio

The primary role of the Patient Access Representative is to serve as liaison between the provider practices and patients in the process of scheduling, obtaining prior authorization for testing, diagnostic imaging, and referrals to other providers. The goal of the Patient Access team is to assure that these processes are managed effectively and efficiently in order to provide seamless and convenient access to specialized services deemed necessary by the patient and their provider to improve health outcomes and utilization of available services within the healthcare delivery system.

• High School Diploma or equivalent

• Minimum of one (1) year of physician office experience.

• Knowledge of medical terminology

• Knowledge of ICD-10 and CPT codes for the purpose of authorizations

• Knowledge of insurance plans and their rules

• Excellent customer service skills

• Effective verbal, written and listening communication skills

• Work independently, self-motivated, and prioritize.

• Establish and maintain effective working relationships with patients, medical staff, and co-workers

• Work with a diverse patient, physician and coworker population

• Proficient computer skills – data entry, retrieval and report generation.

• Able to multitask in multiple software systems

• Responsible for total coordination and processing of all patient referrals for diagnostic testing and specialty services.

• Verify insurance eligibility and benefits and update the patient’s insurance information as necessary.

• Identify the referral and authorization requirements of the patients’ insurance plans by using various on-line resources according to department workflows.

• Demonstrate the ability to request, prepare, and recognize the documentation required to support the medical necessity for the service being authorized.

• Enter all referral authorizations into the computer system. Maintain tracking of referral reports not received and timely follow-up in accordance with the office policy and procedures.

• Maintain tracking of patients referred but not following through with a referral appointment and document patient response or lack of.

• Review details and expectations about the referral appointment with the patients.

• Complete referrals and prior authorizations in a timely manner according to department guidelines and workflows.

• Communicate clearly and effectively with patients, physicians, office staff and manager to resolve issues that may result in a denied or delayed authorization request.

• Schedule patient as per provider referral order for diagnostic testing, therapy or specialist appointment at network facilities or specialty office.

• For specialist referrals, assemble pertinent office notes, labs, testing, etc., fax to specialist office and give patient information regarding specialist information.

• For diagnostic testing advise patient of date, time and necessary test preparations. Check chart for test orders and make sure it has been faxed to the appropriate facility. If order is not present in chart, send note to provider to order the test in the chart and fax to appropriate facility.

• A patient note containing referral information is sent to the primary referral coordinator for necessary insurance pre-authorizations and saved to chart when process is completed.

• Demonstrate complete system knowledge, ability to run reports, document and manage referrals and authorizations, move correspondence, resolve eligibility and authorization holds, and other system tasks within the user’s security access.

• Provide the supervisor and manager with immediate feedback on issues affecting workflow, reimbursement, and customer service.

• Ensure that appropriate and accurate information is entered in the patient account.

• Respond timely and collaborate effectively with revenue cycle, operations or any other colleagues to limit denials and ensure proper reimbursement.

• Exhibit excepted level of teamwork, professionalism and respect. Collaborate with team members to meet department deadlines and benchmarks.

• Anticipate and perform necessary job duties.

• Maintain patient confidentiality

• All special projects work, additional tasks, or other duties as assigned

• Follow all Policies and Procedures

• Meet/Exceed established quality and productivity expectations

• Maintain attendance according to departmental standards

• Complete safety evaluation, JCAHO education, Confidentiality, Information system usage, HIPAA corporate compliance education on an annual basis.

• 8:00am – 5:00pm M-F or hours as required by the job.

• Patient Access Representatives work from home with very limited time onsite for meetings

• May require occasional paid overtime.

• Expected to adhere to office policy and procedures.

• Subject to frequent interruptions and changes in priority of duties throughout the day.

Category III - Includes tasks that involve no exposure to blood, body fluids, or tissues and Category I tasks are not a condition of employment. The normal work routine involves no exposure to blood; body fluids or tissues (although situations can be imagined or hypothesized under which anyone anywhere might encounter potential exposure to body fluids.) Persons who perform these duties are not called upon as part of their employment to perform or assist in emergency care or first aid or to be potentially exposed in some other way.

Demands

Frequency

Remarks

Lifting 0-10 lbs

Occasional 10-33%

Lifting 10-20 lbs

Never

Lifting 20-35 lbs

Never

Lifting 35-50 lbs

Never

Lifting 50-75 lbs

Never

Lifting 75-100 lbs

Never

Lifting over 100 lbs

Never

Forward Reaching

Continuous 66% of the day

Overhead Reaching

Never

Standing

Never

Walking

Never

Sitting

Continuous 66% of the day

Climbing

Never

Stairs/Ladder

Never

Bending/Stooping

Never

Twisting/Turning

Never

Kneeling/Squatting

Never

Crawling

Never

Pushing/Pulling 0-10 lbs

Never

Pushing/Pulling 10-20 lbs

Never

Pushing/Pulling 20-35 lbs

Never

Pushing/Pulling 35-50 lbs

Never

Pushing/Pulling 50-100 lbs

Never

Pushing/Pulling over 100 lbs

Never

Carrying 0-10 lbs

Occasional 10-33%

Carrying 10-20 lbs

Never

Carrying 20-35 lbs

Never

Carrying 35-50 lbs

Never

Carrying 50-100 lbs

Never

Carrying over 100 lbs

Never

Grasping/repetitive sustained

Never

Fine motor coordination

Never

Vision: Near/Far/Color

Continuous 66% of the day

Hearing: ordinary conversation/other

Continuous 66% of the day

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, gender identity, sexual orientation or protected veteran status. AultCare is an EEO/AA Employer M/F/Disability/Vet.

AultCare/AHS will provide reasonable accommodations to employees or applicants with disabilities, as defined by the Americans with Disabilities Act, who are otherwise qualified to safely perform the essential functions of the job, with or without accommodation, unless such accommodation would constitute an undue hardship on AultCare/AHS or poses a direct threat to the health and safety of the individual or others that cannot be sufficiently mitigated by reasonable accommodation. Any applicant or employee who requires an accommodation to perform the essential functions of his or her job or to enjoy equal benefits and privileges of employment should notify the Aultman Human Resource Department and request such an accommodation.