Patient Access Insurance Spec - Insurance Patient Access

Lakeland Regional Health is a leading medical center located in Central Florida. With a legacy spanning over a century, we have been dedicated to serving our community with excellence in healthcare. As the only Provisional Level 1 Trauma center for Polk, Highlands, and Hardee counties, and the second busiest Emergency Department in the US, we are committed to providing high-quality care to our diverse patient population. Our facility is licensed for 910 beds and handles over 200,000 emergency room visits annually, along with 49,000 inpatient admissions, 21,000 surgical cases, 4,000 births, and 101,000 outpatient visits.

Active - Benefit Eligible and Accrues Time Off

This position is responsible for verifying and interpreting insurance benefits or scheduling patients for procedures, Ambulatory/Hospital Based Clinic appointments. Secures referrals and authorizations as appropriate for all scheduled and unscheduled patients, utilizes appropriate reports as required to determine authorization requirements for procedure/test being performed and validating accompanying diagnosis, admission location, pre-admit/admit Physician order, and correct account booking. Calculates, quotes,
and secures the collections for the patient’s uninsured amount, forwards information and collaborates with the Hospital Eligibility Vendor and/or the Financial Counseling team to help unfunded patients. Adhering to LRH's Behavioral Standards, pre-registers patients and gathers required information by phone or direct interview, communicates to the patient or designated healthcare
surrogate clinical pre-procedure instructions with appointment time and which location to report.

People At The Heart Of All We Do

• Fosters an inclusive and engaged environment through teamwork and collaboration.
• Ensures patients and families have the best possible experiences across the continuum of care.
• Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created.
• Safety And Performance Improvement
  • Behaves in a mindful manner focused on self, patient, visitor, and team safety.
  • Demonstrates accountability and commitment to quality work.
  • Participates actively in process improvement and adoption of standard work.
  • Stewardship
  • Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities.
  • Knows and adheres to organizational and department policies and procedures.
  • Standard Work Duties: Patient Access Insurance Specialist
  • Responsible for performing all automated functions for registration, insurance verification, pre-certification, authorization/referral, scheduling and other patient access processes as needed prior to the patient presenting for services and continuing to follow the patients through their visit until discharge.
  • Works daily assignment to completion as follows: Pre-processing: All schedules reviewed and accounts worked to completion for authorization and pre-registration (including but not limited to confirming demographics, quoting patient’s patient responsibility and collecting the patient’s estimated patient responsibility) for the three days prior to admission/registration scheduled arrival. Follows hospital Pre-Scheduling policy for pre-scheduled patient procedures. Follow-up: Complete all work ques and daily reports. Scheduling/Referrals Coordinator: Processes all incoming physician orders for scheduling purposes. Front desk: Verify demographics, capture any insurance changes, obtain signatures on any regulatory forms, and collect any patient estimated responsibility. Operator/Plan of Care: Answer the telephone with a smile and provide excellent customer service, direct all incoming calls timely, and obtain the physician signature timely for the plan of care workflow.
  • Uses expert knowledge of insurance rules and regulations to verify, interpret and communicate insurance eligibility and benefits to patients, physician's office staff, hospital staff and others. Ensure that the appropriate insurance payer order is established in the patient record. Be proficient in all online verification tools (ie: eCare, Availity, payer websites) and correct any errors before the end of their shift.
  • Calculates patient uninsured amount using all available tools and communicates insurance benefits and patient financial responsibility to the patient or guarantor as appropriate while also verifying registration information including but not limited to updating demographics and obtaining appropriate signatures. Notify and collect estimated patient responsibility from the patient/guarantor. Collaborate with the Hospital Eligibility vendor and/or the Financial Counseling team as appropriate for assistance with uninsured/under-insured patients.
  • Obtains/confirms pre-certification, referral and/or authorization, including the necessary information for pre-certification/notification as required for scheduled procedures/appointments, ER admissions, and direct admissions by utilizing electronic and other methods, contacting the insurance company, or physician's office to secure approval for payment for the organization. Collaborates with physicians and/or their office staff to secure pre-authorization/referral for pre-scheduled/scheduled services. Also, collaborates with the UR and Case Management departments as needed to ensure clinical documentation is submitted when required.
  • Actively participates in personal and team development, accomplish department goals, objectives and dashboards, maintaining a positive attitude while minimizing negative behaviors and practicing my always behaviors.
  • Actively clear daily any multi-patient caring lists; worklist; work-que and plan of care requests before the end of scheduled shift
  Accept delegated responsibilities on assigned shift including coverage of other locations if needed.
  
  
  

Essential:

• Demonstrated knowledge of pre-registration, registration and authorization processes and requirements.
• Demonstrated analytical and proficiency in math skills using math competency during departmental interview process.
• Demonstrated knowledge of CMS rules and regulations, managed care, commercial, third party liability, worker's compensation and other insurance payers not listed here.
• Computer-based applications and strong PC/keyboard skills with focus on Word, Excel or other Microsoft applications. Ability to type 45 WPM and data entry skills.
• Demonstrated effective problem solving, multi-tasking, decision-making, interpersonal, and team work skills. Demonstration of professional and effective verbal and written communication. Demonstration of positive customer service skills with an overall positive, resourceful attitude, and proper telephone etiquette.

• Demonstrated working knowledge of all of the above in a hospital or physician office setting with emphasis on hospital and healthcare policies.
• Demonstrated knowledge of the hospital Revenue Cycle.
• Demonstrated proficiency with Cerner/Epic/Mosiac or other registration system applications (scheduling, orders, powerchart, etc).
Demonstrated working knowledge of CPT and ICD10 coding.

Essential:

• High School or Equivalent

Nonessential:

Other information:

- External candidates - Three or more years of experience in a hospital or physician office setting, with emphasis in scheduling patients for services.

- Internal Candidates - One to two years of experience in a Patient Access, Client Services Rep or Patient Financial Services position.

- Ability to work with diverse groups including physicians, physician office staff, clinicians, patients, family members and other community members.

Experience Preferred:

- External candidates - Five or more years of experience in a hospital or a physician office setting, with an emphasis in scheduling patients for services, verifying insurance eligibility and benefit interpretation, obtaining authorization/referral and/or precertification for service, and calculation and collection of patient uninsured amount.

- Internal candidates – Two or more years of experience in a Patient Access, Client Services Rep or Patient Financial Services position.

Certifications Preferred:

• Certification of medical terminology. CHAA