Patient Access Specialist

at  RWJBarnabas Health

Req #: 0000172902
Category: Billing/Collections/Registration
Status: Full-Time
Shift: Day
Facility: Community Medical Center
Department: Patient Financial Services

QUALIFICATIONS:

Required:

• Minimum of 5 years in Patient Access role
• HS Diploma/GED
• Extensive knowledge of payer authorization requirements
• Data trending and reporting skills
• Knowledge in all aspects of Patient Access work flows
• Advanced Excel experience required
• Medical terminology and computer skills

SCHEDULING REQUIREMENTS:

• Shifts Monday-Friday 7:30am-4pm
• Full-Time, Days

ESSENTIAL FUNCTIONS:

Provides excellent customer service to all patients, colleagues and other external and internal customers
Strong understanding of prior authorization requirements for various services
Experience in authorization submission workflow and related technology (Real Time Authorization, Payer portals, TPA authorization forms, Call to payers to update/upgrade existing authorization
Communicate clearly with clinical staff and payer representatives to authorize services
Review script and/or medical service documentation to ensure authorizations match services provided
Interviews patients, family members and other responsible parties to gather pertinent information
Meets and exceeds department goals including accuracy and productivity
Demonstrates proficiency in the entire pre-admission, registration, and financial clearance processes
Demonstrates initiative and motivation in role; proactively identifies and resolves problems in an appropriate manner and escalates issues to leadership when necessary
Utilize system generated reports to analyze data
Analyze denial data to determine root cause, identify issues and areas of opportunity
Create tracking and trending reports
Provide summary findings and recommendations to leadership teams
Assist with creating action plans to address and resolve issues pertaining to incorrect insurance and authorization denials
Develop reports to quantify the value and financial risk for each area
Audit and review work flow, patient processing and quality standards
Reflects commitment to building a supportive work environment and maintains a positive attitude
Works closely and professionally with clinical staff and ancillary departments to foster a team environment
Participate in training through the development of training tools, presentations at department in-services or staff meetings, or through the training of registration staff outside of the patient access department
Other duties as assigned

OTHER DUTIES:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.