Where is this Patient Access Coordinator job located?

Allentown, Pennsylvania, 18103, United States

What type of employment is offered for this Patient Access Coordinator role?

Full-time or part-time position

What industry does this Patient Access Coordinator position belong to?

This role spans multiple industries.

What is the expected salary for this Patient Access Coordinator job?

Compensation will be discussed during the hiring process.

How can I apply for the Patient Access Coordinator position at Good Shepherd Rehabilitation Network?

You can apply directly through the application link provided.

Patient Access Coordinator at Good Shepherd Rehabilitation Network

JOB SUMMARY
- Maintains the Good Shepherd Psychology Group billing services by posting all charges and payments for the purpose of maintaining a current AR flow. Assures psychologists are credentialed in appropriate insurances to produce revenue. Assists Manager of Patient Access with verification and authorization process and denials management for outpatient therapy.
ESSENTIAL FUNCTIONS
- ADMINISTRATIVE SUPERVISION
  - Organizes workflow to be efficient and to maximize services performed to ensure uninterrupted service and revenue flow for psychologists.
  - Ensures compliance with health insurance regulations, medical laws, high ethical standards.
  - Tracks financial performance including impact of changes in insurance reimbursement, patient payer mix.
- ASSURES REFERRAL AND AUTHORIZATION OBTAINED
  - Assures proper referral forms or preauthorization is obtained prior to visit for psychologists.
  - Directly communicates with other providers, insurance companies as required to obtain proper referrals and authorizations prior to providing services.
- PREPARES BILLING
  - Attaches appropriate modifiers, ICD9 and CPT codes to patient encounters, monitoring accuracy of charges submitted by psychologists
  - Assures that necessary referral and/or authorization information is attached to all bills prior to submission to payers
  - Keeps up-to-date with coding guidelines and insurance-specific guidelines and procedures, thereby limiting delayed payments, denials and appeals
  - Performs transaction entry into the billing system
  - Processes HCFA and other insurance billing forms and patient statements
  - Reconciles accounts and makes daily deposits
- REVENUE CYCLE/FINANCIAL PERFORMANCE
  - Requests medical records and other information required for claims, attaching any necessary paperwork to claims
  - Tracks charges from billing to payment to identify and maximize efficiency in receiving payment
  - Directly contacts insurance companies to resolve disputed claims and appeals to maximize revenue.
  - Keeps abreast of billing and payment trends/regulations with regard to behavioral health billing in context of medical setting
  - Acts as liaison between patient and psychologist to address billing questions, concerns and discrepancies
  - Interacts with patients to collect outstanding balances and keep patient portion of accounts current
  - Takes all appropriate steps necessary to appeal denied claims, seek appropriate reimbursement
- ASSURES PSYCHOLOGISTS ARE CREDENTIALED IN ALL IN-NETWORK INSURANCES
  - Regularly updates list of in-network insurances
  - Submits applications for credentialing as appropriate to maintain insurance participation parity with GSRN to every extent possible
  - Obtains necessary paperwork for credentialing and re-credentialing of psychologists and assists in completion and timely submission, tracking progress in credentialing process
  - Identifies problems with payers related to credentialing and plan participation and acts to resolve issue, including investigation of single-case agreements or other options when necessary
- TRACKS STATISTICS
  - Runs end of month reports
- OUTPATIENT SERVICES OFFICE FUNCTIONS
  - Utilizes patient EMR system.
  - Collects and verifies insurance information for new and existing patients who have a change in insurance during course of care.
    - Attains correct insurance benefit information from insurers.
    - Communicates benefits, and potential financial responsibility to patients.
    - Collects patient copays at time of service and consolidates payments on a weekly/daily basis based on location.
    - Follows up with patients who have out-of-pocket costs.
    - Communicates with and resolves patient questions regarding insurance and benefits.
  - Obtains authorization for necessary services from insurers for patient.
    - Performs accurate and timely maintenance of authorization functions, referrals and visit limit tracking in Cerner.
    - Prevents disruption of service by securing necessary authorizations prior to the end date after consulting with therapist.
    - Answers patient calls regarding authorization questions.
    - Researches denials due to authorization or referral issues to determine cause and resolution; resubmits claims after gathering necessary information.
  - Researches denials due to authorization or referral issues to determine cause and resolution; resubmits claims after gathering necessary information.
  - Performs other duties as requested.
- CONTRIBUTES TO TEAM EFFORT
  - Provides coverage for verification and authorization at Hyland Center.
  - Demonstrates flexibility in helping to provide necessary logistical support for Psychology and other facility colleagues, if needed.
  - Provides education to others, contributing from own areas of professional expertise
  - Promotes positive work environment
- PROTECTS PATIENT'S RIGHTS
  - Maintains confidentiality of personal and financial information in accordance with facility policies and legal regulations, including special protections for mental health records
QUALIFICATIONS:
- To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  - Education
    - High School Diploma required
    - Associate's Degree in Secretarial Services or certification from an accredited medical office program preferred
  - Work Experience
    - 3 - 5 years of experience in medical or behavioral health office administration, including customer service, insurance benefits, authorization and claims processing
    - Previous experience with detailed insurance billing and coding, electronic medical record and revenue cycle
    - Physician office billing experience preferred, with experience in mental/behavioral health billing highly desired
  - Licenses / Certifications
    - N/A

Patient Access Coordinator at Good Shepherd Rehabilitation Network – Allentown, Pennsylvania

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