Specialist

at  RWJBarnabas Health

Req #: 0000173367
Category: Billing/Collections/Registration
Status: Full-Time
Shift: Day
Facility: RWJ New Brunswick
Department: Patient Access Services

JOB SUMMARY:

The Patient Access Specialist supports the Patient Access Department by providing key operational functions to identify opportunities and minimize risk. The Patient Access Specialist position plays a key role within the health system by ensuring all steps are taken to financially secure accounts prior to or during service.

QUALIFICATIONS:

Required:

• High School Diploma required
• Minimum of 5 years in Patient Access role
• Extensive knowledge of payer authorization requirements
• Knowledge in all aspects of Patient Access work flows
• Advanced Excel experience
• Knowledge of Medical terminology and computer skills

Preferred:

• College degree preferred

SCHEDULING REQUIREMENTS:

• Day Shift
• Rotating weekends and holidays may be required
• Full-Time

ESSENTIAL FUNCTIONS:

• A core function of this position is to ensure that authorization requirements are met prior to service
• The Patient Access Specialist provides direct and indirect support to department by analyzing data to identify issues and opportunities, reduce denials and improve processes
• The Patient Access Specialist has in-depth knowledge of payer authorization requirements, protocols for obtaining and confirming appropriate authorization for the clinical services rendered and minimizing financial risk
• The Patient Access Specialist has extensive knowledge of payer requirements and is able to clearly understand and articulate with clinical and non-clinical staff
• Provides excellent customer service to all patients, colleagues and other external and internal customers
• Ensures appropriate authorization has been issued by the payer prior to service
• 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:

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.