Patient Access Specialist - Referrals and Authorizations

Patient Access Specialist

Ranked #1 for Safety, Quality and Patient Satisfaction, Jupiter Medical Center is the leading destination for world-class health care in Palm Beach County and the greater Treasure Coast.

Outstanding physicians, state-of-the-art facilities, innovative techniques and a commitment to serving the community enables Jupiter Medical Center to meet a broad range of patient needs. Jupiter Medical Center is the only hospital in Palm Beach, Martin, St. Lucie and Indian River counties to receive a 4-star quality and safety rating from the Centers for Medicare & Medicaid Services (CMS).

Education : High School Graduate or Equivalent, Billing and Coding Certification preferred Experience / Qualifications : Experience required in using EMR systems, insurance verification, eligibility, and electronic billing. Requires general and specific knowledge of health insurance plans and interpretation of health insurance benefits. Extensive knowledge of current billing and coding rules and regulations and use of CPT & ICD 10 codes including appropriate modifiers for Radiation Oncology, Infusion and Oncology Surgery. Ability to read, understand, and adhere to CMS & NCCN guidelines and compliance. Ability to maintain confidentiality. Experience in a customer support role. Medical terminology knowledge. Proficient skills in computer applications such as Microsoft Office. Ability to set priorities and manage time effectively. Flexible, service oriented, and dedicated. Exceptional communication skills both verbally and in writing. Superior organizational skills, attention to detail, and able to multi-task. Strong interpersonal skills, listening and ability to carefully follow directions.

Position Summary The Patient Access Specialist will be responsible for delivering a dynamic customer experience to all customers and demonstrate a strong commitment to service excellence. The Patient Access Specialist is responsible for obtaining demographic, insurance, and medical information to ensure an accurate and complete registration. Performing insurance verification, data collection and documentation. Determine medical necessity for services based on established medical criteria. Identifying patient financial responsibilities and collecting applicable monies. Acting as liaison to all internal and external customers to facilitate access to hospital services. Secures all necessary documentation to register the patient's visit. Reviews all documentation to ensure coding by provider is supported and accurate. Applies all coding rules and use of CPT and ICD 10 codes and appropriate use of modifiers. Assist manager in educating physicians and staff in requirements of documentation for proper reimbursement. Assists in conducting internal audits of patient charges and corresponding documentation, reports, and tracks on a monthly basis. Submit claims and works rejections for claims submission, daily. Checks for data errors and uses them as examples for educating team members. Determines problems that resulted in a rejected claim, resolve, advises on procedural changes to implement, and prevent further such rejects. Resubmits / refiles, print records as needed to appeal rejected claims, as is necessary. Check coding and post charges. Adhere to contractual requirements of Medicare, Medicaid, and managed care plans. Scrubs and reviews charges before claims are submitted. Reviews surgical claims and post-op visits to ensure we capture a full reimbursement. Run daily update and insurance exception reports. Review and correct, re-scrub rejected claims. Performs other duties as assigned.