Patient Access Ambulatory Specialist - Patient Access * Days (M-F ) - 40hrs/wk (Remote Opportunity)

Under the direct supervision of the Manager – Patient Access, the Patient Access Ambulatory Specialist is responsible for the verification of benefits, insurance eligibility, estimates, and pre-certification/authorization requirements for all outpatient surgeries, admissions, endoscopy procedures, and heart & vascular testing. The Specialist works closely with insurance companies, utilization review nurses, and physician offices to ensure accurate and timely billing for reimbursement.

Requirements:

• High School diploma, GED, or equivalent required.
• College Education: 1-2 years preferred.
• Certified Healthcare Associate Certification (CHAA) preferred.
• 2-3 years prior experience in Revenue Cycle or equivalent education.
• Medical Terminology preferred.
• Knowledge of CPT-4 and ICD-10 recommended.
• Coding certification preferred.

Essential Functions & Responsibilities:

1. Responsible to obtain and/or verify demographic, financial, and insurance information from patients and/or their representatives to ensure prompt insurance reimbursement.
2. Responsible to verify benefits, insurance eligibility, pre-certification/authorization requirements and obtain consents when appropriate.
3. Utilize RTE and/or websites to validate and confirm authorizations, coverage of benefits and eligibility status while adding payer specific information into the Auth/Cert screen in Epic.
4. Responsible to create estimates and educate patients of their out-of-pocket costs, deductibles or co-insurance and collect when appropriate.
5. Responsible for daily reconciliation of cash drawer at the end of each shift.
6. Provide timely notification to payer of admission status based on the specific payer requirements.
7. Deliver initial Important Message of Medicare (IMM) letter to patients at the time of admission.
8. Ensure authorization for required procedures per payer has been completed and entered in Epic prior to surgery for inpatient, surgery admits, and observation patient class. Include all components of the authorization within the Epic Auth/Cert screen to ensure accuracy such as insurance, auth number, valid auth date range, and CPT codes.
9. Provide friendly, timely customer service to both internal and external customers seeking information regarding the authorization, notification, and coverage.
10. Provide information to patients regarding financial support that may be available and coordinate with a Financial Counselor for follow up.
11. Provide detailed notes to ensure a smooth transition of the Revenue Cycle process on every chart.
12. Performs other duties as assigned. These may include but are not limited to: Maintaining a current knowledge base of department processes, protocols, and procedures, pursuing self-directed learning, and continuing education opportunities, and participating on committees, task forces, and work groups as determined by management.