Job Overview:
In this key role, the Patient Access Specialist supports the Patient Access Department by providing key operational functions to identify opportunities and minimize risk. The Patient Access Specialist position plays a key role within the health system by ensuring all steps are taken to financially secure accounts prior to or during service. A core function of this position is to ensure that authorization requirements are met prior to service. The Patient Access Specialist provides direct and indirect support to department by analyzing data to identify issues and opportunities, reduce denials and improve processes. This role also works post discharge account edits to ensure clean accounts and timely filing.
The Patient Access Specialist has in-depth knowledge of payer authorization requirements, protocols for obtaining and confirming appropriate authorization for the clinical services rendered and minimizing financial risk. The Patient Access Specialist has extensive knowledge of payer requirements and is able to clearly understand and articulate with clinical and non-clinical staff.
Qualifications:
Required:
Certifications and Licenses Required:
Scheduling Requirements:
Essential Functions:
Provides excellent customer service to all patients, colleagues and other external and internal customers
Strong understanding of prior authorization requirements for various services
Experience in authorization submission workflow and related technology (Real Time Authorization, Payer portals, TPA authorization forms, Call to payers to update/upgrade existing authorization
Communicate clearly with clinical staff and payer representatives to authorize services
Review script and/or medical service documentation to ensure authorizations match services provided
Interviews patients, family members and other responsible parties to gather pertinent information
Meets and exceeds department goals including accuracy and productivity
Demonstrates proficiency in the entire pre-admission, registration, and financial clearance processes
Demonstrates initiative and motivation in role; proactively identifies and resolves problems in an appropriate manner and escalates issues to leadership when necessary
Utilize system generated reports to analyze data
Analyze denial data to determine root cause, identify issues and areas of opportunity
Create tracking and trending reports
Provide summary findings and recommendations to leadership teams
Assist with creating action plans to address and resolve issues pertaining to incorrect insurance and authorization denials
Develop reports to quantify the value and financial risk for each area
Audit and review work flow, patient processing and quality standards
Reflects commitment to building a supportive work environment and maintains a positive attitude
Works closely and professionally with clinical staff and ancillary departments to foster a team environment
Participate in training through the development of training tools, presentations at department in-services or staff meetings, or through the training of registration staff outside of the patient access department
Other duties as assigned
Other Duties:
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Benefits and Perks:
At RWJBarnabas Health, our market-competitive Total Rewards package provides comprehensive benefits and resources to support our employees physical, emotional, social, and financial health.
Paid Time Off (PTO)
Medical and Prescription Drug Insurance
Dental and Vision Insurance
Retirement Plans
Short & Long Term Disability
Life & Accidental Death Insurance
Tuition Reimbursement
Health Care/Dependent Care Flexible Spending Accounts
Wellness Programs
Voluntary Benefits (e.g., Pet Insurance)
Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more!
Additional Information:
Choosing RWJBarnabas Health!
RWJBarnabas Health is the premier health care destination providing patient-centered, high-quality academic medicine in a compassionate and equitable manner, while delivering a best-in-class work experience to every member of the team. We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health.
RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education.
Equal Opportunity Employer
RWJBarnabas Health is an Equal Opportunity Employer
