Lead Patient Access Representative

Job Description

Additional Job Information

• 40 Hours Per Week
• Monday through Friday
• 7:00 a.m. to 3:30 p.m.
• Benefits start first day of employment!
• Location: Nifong Clinic

Overview

Job Summary:

This role is critical in the financial clearance process which assists Boone Health in securing the appropriate authorization and/or Notice Of Admission (NOA) in order to prevent rescheduling the patient or risking net revenue loss. This position is required to obtain authorization on behalf of physicians and Boone Health and must maintain positive relationships. This position ensures the technology is built in a way to accurately support the scripting and validation of authorization and NOA. Without the above we are limited in our collection of payment.

The role represents Boone Health with the highest standard of customer service, compassion and perform all duties in a manner consistent with our mission, vision, values, and service standards. Facilitates certain components of the patients’ entrance into any Boone Health facility, including insurance validation, benefit verification, pre-certification & financial clearance. Responsible for ensuring that the most accurate patient data is obtained and populated into the patient record, particularly authorization data and status. This team member must possess exceptional attention to detail & maintain knowledge & competence with insurance carriers, Medicare guidelines & federal, state & accreditation agencies.

 Job Responsibilities:

• Requires a high level of attention to detail along with a high degree of accuracy. Key components of the process include validation of the following: patient information, scheduled test/surgery information, and insurance information. Ensures that the authorization detail placed in the patient’s medical record is accurate. Expected to utilize critical thinking skills to research and resolve any mismatch in information which could involve various orders/scheduling, registration and insurance systems. Additionally, departmental processes around data capture must be followed and appropriate.
• Communication is a key. This position has high visibility and interaction with provider offices, insurance companies, as well as some patient interaction (typically phone calls for rescheduling appointments under the scope of the Ancillary Authorization process). This team member must communicate in a professional manner with particular emphasis on positive and respectful interaction with patients and offices. They must also be able to provide consistent excellent customer service in a variety of situations.
• The ability to promote teamwork and employee engagement is everyone’s responsibility. This team member will work to create an atmosphere of teamwork by contributing to opportunities to improve employee engagement and customer satisfaction. In all situations, they will engage others in a respectful and collaborative manner. They will seek opportunities for self-development (personal and technical) while achieving department objectives and goals.
• This position is part of a multidisciplinary team which provides authorization support for multiple Boone Health Departments. May be responsible for supporting the Ancillary Authorization (scheduled outpatient services), Surgery Authorization (scheduled surgical procedures), or the NOA (Notice of Admission) processes within the Boone Health Pre-Arrival Team. As part of the authorization process, this team member will initiate contact with provider offices, payers and/or payer websites as well as access a variety of systems and tools to secure and validate authorization information. For Ancillary Authorizations, a review of medical records may be required if initiating the authorization request directly with the payer.
• Boone Health has determined this is a safety-sensitive position. The ability to work in a constant state of alertness and in a safe manner is an essential function of this job.
• Performs Other Responsibilities as Assigned.

Minimum Qualifications:

• Degrees:  High School Diploma or GED
• Experience:  2-5 years
• Supervisor Experience: None-Required
• Licenses & Certifications: None- Required

Preferred Qualifications:

• Degrees:  Associates
• Experience:  5-10 years
• Licenses & Certifications: CHAA

Work Shift

Day Shift (United States of America)

Scheduled Weekly Hours

40

Legal Statement

The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job.

Equal Opportunity Employer