Patient Access/Prior Authorization (FT)

With a range of services - from emergency care to diagnostic imaging, rehabilitation and surgery - we serve people of all ages in Edgerton, Milton, Janesville and the surrounding communities. Edgerton Hospital has been the center of the community’s health care since 1920, and we continue to grow and evolve in response to changing medical needs.

Our Mission

Improving Health & Wellness for Longer, Healthier Lives

Our Vision

We will serve our communities with exceptional quality, innovative health services and wellness promotion.

Our Values

I CARE
Integrity. Compassion. Accountability. Respect. Excellence.

Join an organization that truly values your overall health and well-being & provides excellent work/life balance! If you are hardworking, dependable, & team-oriented - we'd love to hear from you!

Our Patient Access Level I reports to the Patient Access Director and supports Edgerton Hospital by:

• Ensuring smooth patient experience by accurately completing registration, verifying insurance eligibility, and confirming provider network status
• Generates treatment cost estimates and communicates financial responsibilities with clarity and compassion
• Maintains accurate EMR documentation while collecting payments as required
• Supports overall Revenue Cycle operations through timely patient assistance, adherence to regulatory and payer guidelines, and effective collaboration with clinical and scheduling teams

Essential Role Functions:

Eligibility and Registration

• Interview incoming patients or representatives to gather demographic and insurance data.
• Enter patient information accurately into Epic EMR system.
• Identify primary and secondary payer and plan types.
• Verify insurance benefits, limitations, and eligibility.
• Determine if Medicare is traditional or managed care; identify if Medicare is secondary payer.
• Ensure provider(s) are in-network with insurance plan.

Treatment Estimate

• Generate and review treatment cost estimates for scheduled and unscheduled services.
• Analyze insurance benefits to determine patient out-of-pocket responsibilities.
• Discuss financial responsibility, payment plans, and financial assistance programs with patients in a clear and compassionate manner.
• Document financial counseling and estimate communication accurately in Epic EMR.
• Collaborate with scheduling and clinical teams to ensure estimates align with planned treatments.

General

• Stay current on hospital pricing policies, payer rules, and financial assistance programs.
• Escalate complex financial cases to management as needed.
• Collect co-payment and/or deductible as required.
• Obtain signed statements and consents to protect hospital interests.
• Respond to patient requests regarding account charges in a timely and courteous manner.
• Maintain accurate EMR records and appropriate payer class assignments.
• Stay informed of regulatory changes affecting claims processing.
• Demonstrate knowledge of billing policies and instruct patients and staff as needed.
• Receive payments and accurately record them; ensure cash drawer accuracy.
• Perform general clerical functions including scheduling, filing, and answering telephones.
• Provide quality control feedback related to admissions process.
• Direct patients, visitors, and vendors appropriately.
• Additional duties as requested by Patient Access Director.

Regulatory & Policy Compliance

• Ensure departmental policies and procedures are followed and updated as needed.
• Protects the confidentiality and security of patient health information in accordance with HIPAA and organizational policies.

Collaboration & Communication

• Acts as a liaison between the hospital and providers and patients.
• Participates in committees, project teams, and meetings as needed.

EDUCATION, TRAINING AND EXPERIENCE:

• One year of experience in registration, customer service, or healthcare preferred.
• Basic knowledge of insurance plans, eligibility verification and access to care processes.

SKILLS OR ATTRIBUTES:

• Ability to perform multiple duties with efficiency and composure.
• Take responsibility for planning and controlling activities.
• Make evaluations and decisions based on verifiable criteria.
• Work independently and recognize patient confidentiality rights.
• Convey empathy and compassion.
• Collaborate effectively with team members.
• Communicate effectively with diverse populations.

SPECIAL SKILLS OR OTHER REQUIREMENTS:

• Mathematical ability for reviewing financial data.
• Cash handling and money counting accuracy.
• Computer proficiency including10-key, typing, and Epic EMR use.
• Excellent customer relations skills.

We are looking for a full-time, benefit eligible, Patient Access Level I, who will support our Patient Access department at both our Main Hospital and Quick Care locations. This individual will also perform prior authorization duties.

Details -

• .75 FTE (30 hours per week)
• Mondays: 11:30AM - 7PM at our downtown Edgerton Quick Care location
• Tuesdays - Thursdays: 11:30AM - 5PM Prior Authorization duties at our Main Hospital location.

Let's talk Benefits -

• Starts Day 1 - no waiting period!! (Except 401(k))
• Health Insurance
  • Our health plan is unmatched by offering a $0 deductible & co-pay option.
• Dental
• Vision
• Employer paid Short-Term Disability
• Employee paid Long-Term Disability
• Employer Paid Life Insurance & AD&D
• Voluntary Supplemental Life Insurance & AD&D
• Flex Spending
• 401(k) & Employer Match
• EAP - Employee Assistance Program
• Generous PTO offering