AMVETS Jobs

POSITION PURPOSE

The Patient Access Specialist functions as an integral member of a multidisciplinary clinical team which manages the care of patients. Patient Access Specialist will verify patient's health benefits and coverage for infusion services. The Patient Access Specialist works closely with the Intake Coordinator to process new referrals timely. Ensures accurate and complete verification of insurance benefits. Communicates insurance benefits to include any co-pay or co-insurance to the Patient Account Specialist/Admin Assistant. Works closely with clinical staff and Reimbursement team in providing and promoting customer service, process flow, operational integrity, quality care and process improvement along with high service standards. Represents self in a professional and ethical manner at all times.

QUALIFICATIONS/REQUIRED EDUCATION/TRAINING

Experience:

• Two (2) plus years of medical insurance case management experience required.
• Medical terminology and coding experience required.

Education:

• High School Diploma or equivalent.

Preferred:

• Graduate from an accredited school of nursing with RN or LPN degree.
• Experience in a clinical specialty involving infusion therapy desirable.

Other Qualifications:

• A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers.
• Must be able to assume a flexible work schedule.
• Strong organizational, communication and problem solving skills.
• Excellent internal and external customer service.

Interpersonal Skills:

• Must have excellent interpersonal skills in handling interactions with Palmetto Infusion staff, other agencies, groups, patients and families.

Technology Skills:

• Competent in use of company email as means of communication, accessing the company website to view company policies and electronic medical records.
• Competent in the use of company self-service payroll software (time and attendance, benefits, pay statements).
• Competent in the use of Microsoft Office products and the ability to navigate Internet Explorer. Proficient in typing, word processing (Microsoft Office/Express, Word, Excel), and familiar with office equipment.
• Proficient in the operation of the current EMR software.

Language Skills:

• This position requires a knowledge of, and sensitivity to, cultural and language differences.

Mathematical Skills:

• Must have the ability to perform basic mathematical computations. Ability to apply concepts such as fractions, percentages, ratios and proportions to practical situations.

Reasoning Ability

• There are a number of deadlines associated with this position. The employee must also multi-task and interact with a wider variety of people on various and, at times, complicated issues.

Physical Demands

• The physical demands described here are representative of those that must be met by an employee to successfully perform the primary functions of this job. While performing the duties of this job, the employee may be required to frequently stand, walk, sit, bend, twist, talk and hear. There may be prolonged periods of sitting, keyboarding, reading, as well as driving or riding in transport vehicles. The employee must occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this job include reading, distance, computer, and color vision. Talking and hearing are essential to communicate with patients, vendors and staff.

Other Skills

• Must be able to work as a team member and develop productive and cooperative working relationships with all members of the Palmetto Infusion team.

ESSENTIAL DUTIES, FUNCTIONS and RESPONSIBILITIES

Provides timely acceptance and completion of new referrals.

Obtains patient data from referring physician office for support of medical necessity; ensures data integrity.

Reviews payor medical policy to determine medical necessity based on payor guidelines and/or FDA indications.

Understands Medicare coverage principles and requirements.

Performs insurance verification for new patients.

Provides clinical knowledge and acts as a clinical resource to non-clinical staff members.

Documents in the EMR system clinical rational supporting approving or denying a service based on payer medical polies and/or FDA indications.

Provides the initial clinical review to determine medical necessity based on the payer's medical policy and/or FDA indications, primary for new referrals.

Assists with evaluating the financial appropriateness of new referrals.

Follows the Intake process timeline for processing new referrals.

Obtains initial authorization and reauthorization as applicable.

Completes the insurance verification in the EMR software and ensures the documentation obtained from the payor's website is scanned into the patient medical record.