Overview
Patient Access Insurance Spec – Insurance Patient Access Jobs in Lakeland, FL at Lakeland Regional Health
Position Information
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: 210 Office Building, US:FL:Lakeland
Position Summary
Summary:
This position is responsible for verifying and interpreting insurance benefits or scheduling patients for procedures/Hospital Based Clinic appointments. 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 the collections for the patient’s uninsured amount, forwards information and collaborates with the Hospital Eligibility Vendor and/or the Financial Counseling team to help 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.
Position Details
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 and continuing to follow the patients through their visit until discharge.
Works daily assignment to completion as follows: Pre-processing: All schedules reviewed and accounts worked to completion for authorization and pre-registration (including but not limited to confirming demographics, quoting patient’s patient responsibility and collecting the patient’s estimated patient responsibility) for the three days prior to admission/registration scheduled arrival. Follows hospital Pre-Scheduling policy for pre-scheduled patient procedures. Follow-up: Complete all work ques and daily reports. Scheduling/Referrals Coordinator: Processes all incoming physician orders for scheduling purposes. Front desk: Verify demographics, capture any insurance changes, obtain signatures on any regulatory forms, and collect any patient estimated responsibility. Operator/Plan of Care: Answer the telephone with a smile and provide excellent customer service, direct all incoming calls timely, and obtain the physician signature timely for the plan of care workflow.
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. Be proficient in all online verification tools (ie: eCare, Availity, payer websites) and correct any errors before the end of their shift.
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 including but not limited to updating demographics and obtaining appropriate signatures. Notify and collect estimated patient responsibility from the patient/guarantor. Collaborate with the Hospital Eligibility vendor and/or the Financial Counseling team as appropriate for assistance with uninsured/under-insured patients.
Obtains/confirms pre-certification, referral and/or authorization, including the necessary information for pre-certification/notification as required for scheduled procedures/appointments, 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 Case Management departments as needed to ensure clinical documentation is submitted when required.
Actively participates in personal and team development, accomplish department goals, objectives and dashboards, maintaining a positive attitude while minimizing negative behaviors and practicing my always behaviors.
Actively clear daily any multi-patient caring lists; worklist; work-que and plan of care requests before the end of scheduled shift.
Qualifications & Experience
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
Title: Patient Access Insurance Spec – Insurance Patient Access
Company: Lakeland Regional Health
Location: Lakeland, FL
