Patient Access Specialist

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. High School diploma or equivalent.

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Associate degree in a related medical field such as medical assisting or medical office administration.

EXPERIENCE:

1. Experience in a medical office setting.

CORE DUTIES AND RESPONSIBILITIES:The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Obtains demographic/billing/insurance information from patient/family/legal guardian and enters into the registration/billing systems for service and claim processing and scans insurance cards & photo identification.

2. May complete managed care responsibilities in regard to obtaining pre-certification and authorizations.

3. Prepares WVU Medicine standard consent form, notice of privacy practice and/or other necessary paperwork related to registration and presents to patient/family/legal guardian for signatures. Obtains electronic signature for consent to treat and patient financial obligations.

4. Collects deposits/co-payments/deductibles/patient liability payments when applicable, provides patient receipt and documents payment in the registration/billing systems.

5. Directs patients needing financial assistance to speak with a Financial Counselor.

6. Prepares armband for patient identification.

7. Balances daily receipts and cash drawer for patient payments as needed.

8. Follows up on accounts as indicated by system flags (courtesy dismissal/comments/red stickers).

9. May initiate auto accident liability coverage. Identifies all patients involved in an auto accident and obtains all pertinent information regarding medical or non-fault liability and documents in registration/billing systems.

10. May initiate ERSD (end stage renal disease) screening. Identifies ESRD patients and obtains all pertinent information regarding coverage by SSI and documents in the registration/billing systems.

11. May initiate Veterans Administration eligibility screening. Identifies all VA eligible patients and coordinated admission/treatment with VA and documents in the registration/billing systems.

12. May initiate Black Lung SSI screening. Identifies all patients covered under Black Lung and documents in the registration/billing systems.

13. May initiate Workers Compensation screening. Accurately identifies all patients seeking treatment for work related injuries. Assists in completion of appropriate paperwork and documents in the registration/billing systems.

14. Initiates MSPQ (Medicare secondary payer questionnaire). Obtains all information regarding MSPQ. Documents in registration/billing system all information required on the MSPQ.

15. Maintains confidentiality according to policy and HIPAA when interacting with patients, physicians, families, co-workers and the public regarding demographic/clinical/financial information

16. Provides to the patient, information concerning insurance, payment of bills and hospital procedures. Consistently maintains current knowledge of major payer payment provisions.

17. Performs medical necessity checks and completes Advanced Beneficiary Notice as needed.

18. Answers phone calls in a professional and courteous manner. Uses phone system in correct manner.

19. Schedules, reschedules, or cancels patients in accordance with hospital workflows.

20. Checks for order completeness and validate order against scheduled service.

21. Communicates with and supports hospital departments using the scheduling system.

22. Follows hospital, state, and federal guidelines for ensuring safe environment for workers, patients, and the public. Ensures compliance by staff to hospital, governmental, and insurance regulations.

23. Complies with Notices of Privacy Practices, and the Patient's Rights and Responsibilities and cooperate with the WVUH Corporate Compliance Program during employment.

24. Communicates and interacts with clients, families, visitors, physicians, departmental, and hospital staff and the public in general in a manner that demonstrates professionalism and concern for the individuals' need(s).

25. Participates in the processes to assess and improve the services provided and compliance with regulatory requirements. Reports results of assessments and improvement processes to the appropriate administrative levels.

PHYSICAL REQUIREMENTS:The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Frequent walking, standing, stooping, kneeling, reaching, pushing, pulling, lifting, grasping, and feeling are necessary body movements utilized in performing duties throughout the work shift.

2. Visual acuity must be within normal range.

3. Must be able to exert in excess of 50 pounds of force occasionally, and/or up to 25 pounds of force frequently, and/or up to 10 pounds of force constantly to move objects.

4. Must have manual dexterity to operate keyboards, fax machines, telephones, and other business equipment.

5. Must have the ability to move throughout the work area and clinic area.

6. Must be able to sit or stand for extended periods of time.

8. Must have reading and comprehension ability.

WORKING ENVIRONMENT:The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Must be capable of performing assigned task despite frequent interruptions.

2. Must be capable of working within a confined office space and under fluorescent lighting.

3. Must have ability to maintain concentration in and around noise from office machinery such as a copier or printer.

4. High volume, fast paced environment.

5. Exposure to communicable disease.

6. Interacts with patients, medical staff, and support staff daily on a continual basis.

SKILLS AND ABILITIES:

1. Ability to accurately utilize applicable computer software and equipment for access processing & demonstrates ability to follow down time procedures.

2. Demonstrate knowledge of procedure to report and/or document unsafe/hazardous conditions, incidents and defective equipment in compliance with hospital policy.

3. Requires ability to perform repetitious duties throughout the shift.

4. Requires considerable attention to detail, the ability to be organized and to be able to perform multiple tasks simultaneously.

5. Requires the ability to memorize a considerable amount of information, and to be able to reference information not retained from written sources or from appropriate personnel.

6. Requires the ability to understand medical insurance requirements for payment and basic knowledge of covered services.

7. Must be able to work with a variety of personality types and interact with individuals with various levels of education, capabilities and communication skills.

8. Must demonstrate ability to use tact and diplomacy in dealing with physicians, patients, and families.

9. Excellent communication skills (written and verbal).

10. Basic knowledge of medical terminology preferred.

11. Basic knowledge of third party payers preferred.

12. General knowledge of time of service collection procedures preferred.

13. Demonstrates ability to follow established computer downtime procedures.

14. Ability to understand written and oral communication.

Additional Job Description:

Rotating Holidays

Scheduled Weekly Hours:

Shift:

Exempt/Non-Exempt:

Company:

Cost Center:

Address:

WVU Medicine is proud to be an Equal Opportunity employer. We value diversity among our workforce and invite applications from all qualified applicants regardless of race, ethnicity, culture, gender, sexual orientation, sexual identity, gender identity and expression, socioeconomic status, language, national origin, religious affiliation, spiritual practice, age, mental and physical ability/disability or Veteran status.