Work Type: Active - Benefit Eligible and Accrues Time Off
Exempt: No

Work Schedule: Monday - Friday
Work Hours per Biweekly Pay Period: 80 hours

Shift Time:
Location: Outpatient Rehab North (YMCA), Florida Southern

Summary:
This position is responsible for verifying and interpreting insurance benefits or scheduling patients for procedures through the centralized scheduling unit. Secures referrals and authorizations as appropriate for all scheduled and unscheduled patients, utilizes appropriate reports as required to determine authorization requirements for procedure/test being performed and validating accompanying diagnosis, admission location, pre-admit/admit Physician order, and correct account booking. Calculates, quotes, and secures patient uninsured amount, forwards information and collaborates with the Hospital Eligibility Vendor and/or the Financial Counseling team to provide assistance to unfunded patients. Adhering to LRH's Behavioral Standards, pre-registers patients and gathers required information by phone or direct interview, communicates to the patient or designated healthcare surrogate clinical pre-procedure instructions with appointment time and which hospital location to report.

Detailed responsibilities:

• Standard Work Duties: Patient Access Insurance Specialist
• Responsible for performing all automated functions for registration, insurance verification, pre-certification, authorization/referral, scheduling and other patient access processes as needed prior to the patient presenting for services.
• Works daily assignment to completion as follows: Pre-admission: All procedural schedules for next day's admissions/registrations schedule day assigned in advance of patient's procedures. Follow-up: Daily reports. Scheduling: Processes all incoming physician orders for scheduling purposes.
• Uses expert knowledge of insurance rules and regulations to verify, interpret and communicate insurance eligibility and benefits to patients, physician's office staff, hospital staff and others. Ensure that the appropriate insurance payer order is established in the patient record.
• Calculates patient uninsured amount using all available tools and communicates insurance benefits and patient financial responsibility to the patient or guarantor as appropriate while also verifying registration information. Collaborate with the Hospital Eligibility vendor and/or the Financial Counseling team as appropriate for assistance with uninsured/under-insured patients.
• Obtains pre-certification, referral and/or authorization, including the necessary information for pre-certification as required for scheduled procedures, ER admissions, and direct admissions by utilizing electronic and other methods, contacting the insurance company, or physician's office to secure approval for payment for the organization. Collaborates with physicians and/or their office staff to secure pre-authorization/referral for pre-scheduled/scheduled services. Also, collaborates with the UR and Social Work departments as needed to ensure clinical documentation is submitted when required.
• Execute reports from Cerner/SMS and other scheduling systems to establish patient schedule for next day admissions using Excel and other electronic formats.
• Executes reports daily to ensure pre-admission admit orders are placed for all scheduled patients with correct admission type based on Physician order and pre-admits all scheduled procedures within 24hours of receipt of request.
• Follows hospital Pre-Scheduling policy for pre-scheduled patient procedures.

Education:
Essential:

• High School or Equivalent

Nonessential:

• Associate Degree

Education equivalent experience:
Nonessential:

• Business or Healthcare Finance

Other information:
- External candidates - Three or more years of experience in a hospital or physician office setting, with emphasis in scheduling patients for services, verifying insurance eligibility and benefit interpretation, obtaining authorization/referral and/or precertification for service, and calculation and collection of patient uninsured amount.

- Internal Candidates - One to two years of experience in a Patient Access, Client Services Rep or Patient Financial Services position.

• Ability to work with diverse groups including physicians, physician office staff, clinicians, patients, family members and other community members.

Experience Preferred:
- External candidates - Five or more years of experience in a hospital or a physician office setting, with an emphasis in scheduling patients for services, verifying insurance eligibility and benefit interpretation, obtaining authorization/referral and/or precertification for service, and calculation and collection of patient uninsured amount.

• Internal candidates – Two or more years of experience in a Patient Access, Client Services Rep or Patient Financial Services position.

Certifications Preferred:

• Certification of medical terminology. CHAA