Pre-Access Specialist is responsible for one of the first impressions a patient will have of Billings Clinic. Incumbent will provide education both verbally and via mail in an effort to manage the patient and/or family member’s expectations as a patient of our facility. New and some established patients for both clinic and hospital services will be contacted to obtain all patient and guarantor information, insurance information including any information related to accident insurance, etc. as well as additional contact information. All regulatory requirements as to determination of primary and secondary carrier status will be collected. Staff will inform patient/family member of insurance billing processes as well as payment expectations. Payment policies will be reviewed as well as any need for co-payment and/or coinsurance/deposit requirements. An explanation of what the patient can expect at check-in will be provided as well as information regarding parking, valet services, etc. Patients will be provided with a customized new patient welcome packet including their scheduling itinerary and way finding materials. Through the conversations during registration and demographic information collection, staff will provide patients with information regarding the need to contact Financial Representatives in reference to financial assistance and/or payment arrangements. Addresses will be verified electronically by staff members.

Essential Job Functions

•Supports and models behaviors consistent with Billings

Clinic’s mission, vision, values, code of business conduct and service

expectations. Meets all mandatory organizational and departmental requirements.

Maintains competency in all organizational, departmental and outside agency

standards as it relates to the environment, employee, patient safety or job

performance

•Provides first impression of Billings Clinic to patients

and family members. Focus on patient service is first and foremost.

•Validates insurance entries using Intellisource

software, commercial web site, or calling insurance company and analyzes

electronic/verbal responses ensuring appropriate set-ups dependent upon State

where services are being rendered

•Coordinates with patients,

internal and external providers, nursing staff to ensure Medicaid Passport and

other authorizations for referrals required by insurance carriers are obtained

and entered onto specifically approved encounters within the revenue cycle

system.

•Schedules and coordinates

appointments in a manner that meets the patient’s needs and is in

keeping with each individual

provider’s scheduling protocols for the various appointment types, lengths of

appointments and any pre-appointment requirements as outlined by the providers.

•Review and analyzes AccuReg

edits completes corrections in accordance with AccuReg worklist daily.

•Consistently uses searching

techniques within the Registration system to identify existing Billings Clinic

health information record for additional updating.

•Accurately obtains all patient, guarantors, primary,

secondary and tertiary insurance information from patients and verifies

patient/guarantor primary residence address as well as insurance eligibility

and co-pay requirements on-line. If unavailable on-line, contact insurance

carrier via phone to verify all information. Familiarizes self in various

insurance cards and identification to assist patient in providing accurate

information.

•Participates in quarterly assessments in accordance with

policies and procedures.

•Reviews, analyzes and interprets information obtained to

determine regulatory requirements that may exist including completion of MSPs,

gathering of third party payors in relation to accidents, etc. Maintains this

knowledge for both a clinic and hospital setting.

•Uses processes and information to manage a patient’s

expectations for parking, check-in process, way finding, insurance billing

turnaround times, etc. Prints patient’s custom schedule itinerary, way finding

tools and department specific information along with new patient welcome packet

(if needed) and mails to patient.

•Discusses Billings Clinic expectations for payment of

services by supplying patient with verbal explanation of our payment policies

to include co-pays, coinsurances, and/or deposits to be made at the time of

service in conjunction with Billings Clinic policies and procedures.

•Provides assistance in ensuring patients are directed to

the appropriate resources within the organization if questions arise as to the

patient’s ability to pay. Provides patients with financial assistance

applications if appropriate.

•Ensures all work lists are completed within guidelines

and provides appropriate hand-off information to others to ensure all patients

are contacted.

•Performs other duties as assigned or needed to meet the

needs of the department/organization.