Patient Access Resource Specialist - Inpatient Admitting Emergency Department

SUMMARY:

Assists with coordination of daily operations for scheduling, pre-registration/verification, insurance benefits, and admissions. Engages in training for all new hires and ongoing process changes for the assigned department. Provides employee feedback as needed.

ESSENTIAL FUNCTIONS:

Provides routine daily internal interface with unit/department management and staff, other access service areas, information systems, physicians, and physicians office staff.

Provides external service to patients, physicians, software/hardware vendors, and third party payers.

Assists staff with problem solving, routine questions, and customer interaction to ensure positive results.

Ensures notification of ancillary departments, other access areas and patients, within schedule guidelines, of changes or cancellations by regulatory agencies and third party payers with respect to authorizations, and verification requirements.

Maintains current knowledge of the outpatient scheduling criteria/processes for each ancillary department to ensure correct procedures are scheduled by staff.

Oversees the process of notification to the Financial Counselors when intervention is indicated for potential uncompensated care.

Schedules procedures, participates in pre-registration and financial verifications, obtains insurance benefits, and complete admissions of patients when necessary to ensure the smooth flow of the unit.

Ensures the timely processing of all physician orders, pre-registration, verification of insurance eligibility, benefits, prior authorizations, and medical necessity screening is completed prior to services being rendered.

Interprets and explains to patients and their families charges, services, and hospital policy regarding payment of bills in accordance with TMC HealthCare Credit and Collection policies.

Builds and maintains communication alliances with support and related personnel in the IS department, ancillary departments, nursing units and other financial service personnel.

Evaluates, learns and assists in the implementation of new software programs/systems, and other related technologies.

Communicates information to the Supervisor and/or Manager as needed to ensure a smooth and seamless access process prevails in each registration area.

Exhibits excellence in customer service through appropriate attitude and interaction with all patients, visitors and staff.

Adheres to and supports team members in exhibiting TMCH values of integrity, community, compassion, and dedication.

MINIMUM QUALIFICATIONS

EDUCATION: High school diploma or General Education Degree (GED), or an equivalent combination of relevant education and experience.

EXPERIENCE: Four (4) years of medical insurance, billing and/or scheduling experience; preferably has served as lead over other revenue cycle staff.

LICENSURE OR CERTIFICATION: None required. Certified Healthcare Access Associate (CHAA) certification or proficiency testing strongly preferred.