Patient Access Lead

Job Description

REQUIREMENTS

• Minimum 3+ years of related prior work experience required, preferably in admission, scheduling and medical insurance within the healthcare industry.
• Proven competencies can take precedence over prior work experience.
• High school graduate or equivalent; associates or bachelor’s degree preferred.
• Proficient (intermediate level of application) with all Microsoft Office Products programs.
• Advanced knowledge of insurance, accounting, medical billing, HIPAA, Medicare/Medicaid, medical abbreviations and terminology, required.
• Must possess outstanding communication and interpersonal skills, be able to communicate professionally and effectively with other staff members, patients, vendors and physicians, and is fluent in written and spoken English.
• Experience supporting multiple managers/supervisors.
• Prior experience working with sensitive information and maintaining confidentiality.
• Travel minimal in this role but can be up to 10%.

RESPONSIBILITIES

Primary Responsibilities:

• Subject Matter Expert (SME) in all aspects of the Patient Access functions, responsibilities, and processes & procedures.
• Proficient in all applicable systems, programs, resources, and tools.
• Assists with all Patient Access functions as needed per business demands.
• Knowledgeable of all Patient Services roles and able to assist workload as needed.
• Maintain working knowledge of insurance contracts and exclusions.
• Maintain knowledge of applicable CPT, HCPCS, and ICD-10 codes
• Maintain familiarity with drug copay assistance program requirements to determine whether a patient meets base eligibility conditions.
• Uphold and promote adherence to HIPAA guidelines.
• Generate and manipulate Excel spreadsheets to sort, condense, and prioritize data.
• Demonstrate exceptional written and verbal communication skills when interacting with insurances, referring office staff, patients, and internal & clinical staff.
• Communicate and maintain contact with the Patient Navigator, Medical Records Review, and Patient Resources teams regarding patient accounts, referral documentation, insurance and coordination of benefits concerns, patient financial documents, prior approvals, referrals, etc.
• Utilize appropriate templates, naming conventions, formats, and email distribution lists for system notations and email & task communication.
• Conduct training for new and existing employees, to include onboarding and refresher training sessions.
• Acts as a key point of contact for the Patient Access team
• Assists Patient Access Managers in driving team goals, guidelines, and expectations.
• Monitor team workload and productivity.
• Complete regular Quality Assurance (QA) audits.
• Responds to escalations and concerns.
• Makes recommendations for improvements to established processes and procedures.
• Run and build daily, weekly, monthly, and ad hoc reports for review and assignment.
• Facilitate schedule review reports, authorization tracking, and other routine reports.
• Assist and support leadership in communication regarding process changes, function and responsibility coverage, and guidelines updates.
• Assist with managing the workload and coordinates coverage assistance when necessary to ensure that referrals and orders are handled in a timely manner.
• Identify and escalate team performance issues and communicate concerns to manager.
• Collaborates with manager in educating team members toward improvement and provides peer feedback as directed.
• Act as key participant and co-presenter on weekly calls as outlined by manager

Secondary responsibilities:

• Assist in various projects e.g., claim projects, patient data audits, acquisition assistance, etc.
  • Maintain spreadsheets for data management
• Facilitate month-end in any facet
• Maintain patient records and confidentiality via the electronic Medical Record System
• Develops an effective communication mechanism for the Home Office to promote a positive image with clinics, patients, visitors, co-workers, physicians, office personnel, and external agencies
• Demonstrates our client’s culture
• Attends necessary meetings related to department activities
• Performs other duties as assigned

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