Patient Account Specialist - System Scheduling and PIE Access - Full Time - REMOTE
Performs verification of insurance coverages and prior authorization/certification of scheduled services with payers. Provides clinical review and document submission of pre-certification requests for scheduled elective services. Assists with onboarding and daily questions for new employees.
1. Reviews patient’s insurance coverage for eligibility and network guidelines.
2. Reviews insurance companies authorization guidelines.
3. Checks for the clinical documentation for elective scheduled services such as advance diagnostic imaging and surgical procedures.
4. Initiates the authorization with the payer for those services that doesn’t require a clinical nurse.
5. Follows up with the payers for the authorization decision of approved or denied.
6. Provides communication to the physician offices and patients when a case needs re-scheduled or cancelled.
7. Completes consistent review of individual payer policies to identify changes affecting authorizations. Maintains current knowledge on medical criteria relating to prior authorization requirements by third party payers and medical necessity requirements.
8. Participate in process development and improvement as it relates to authorizations, communication, education, etc.
9. Thoroughly documents actions taken in appropriate information system(s).
10. Self-pay and Referenced based communication to both physician offices and patients.
11. Pricing estimates.
12. Additional responsibilities/duties will be assigned based on team work load and competency
13. Assist with onboarding of new hires. Trainer for the team
14. Provide coaching and mentoring to less experienced staff on their team
15. Cross trained on another folder team preferred but not required
16. Administrator for payer websites or requester for new employee access for their team’s payers
17. Functions as a team member to organize and prioritize responsibilities to complete daily work requirements:
a. Complies with changes in duties and assignments in a positive and cooperative manner.
b. Adjusts to peaks in workload: demonstrates flexibility and adaptability to change.
c. Completes assignments in appropriate time frames.
d. Offers assistance to co-workers to ensure completion of all assigned duties as necessary.
e. Performs duties in a self-directed manner with minimal supervision or direction.
18. Demonstrates a positive, supportive, respectful and helpful attitude in interactions with all department customers (patients, physicians, visitors and other healthcare team members).
19. Shadow other job functions in the department.
20. Demonstrated ability to proficiently navigate Epic, Recondo and any other applicable systems including online payer systems.
21. Other duties as assigned.
PREFERRED / REQUIRED QUALIFICATIONS
Education: Must have a high school diploma or equivalent.
1. Must demonstrate the ability to accurately and independently solve problems by taking a basic skills test and scoring a minimum of 80%
2. Have intermediate computer knowledge, skills and proficiency including general office applications.
3. Have strong organizations skills and the ability to multi-task.
4. Demonstrate the ability to accurately and independently solve problems.
5. Have the ability to manage large volumes of work, ability to quickly learn and retain information regarding issues that present themselves.
6. Having experience health insurance plans and medical terminology is preferred but not required.
Years of Experience: Must have worked 2 years within ProMedica Pre-Access department and have met all KPI expectations to be promoted to Patient Account Analyst Senior Specialist.
ProMedica is a mission-based, not-for-profit integrated healthcare organization headquartered in Toledo, Ohio. For more information, please visit www.promedica.org/about-promedica
Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact email@example.com
Equal Opportunity Employer/Drug-Free Workplace
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