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Billings Clinic Pre Access Specialist I in Billings, Montana

Pre Access Specialist I

Non-Exempt

req618

Day

Full-Time (.75 or greater)

M-F, 8-5

1.00 = 80 hours

Job Summary

Pre-Access Specialist is responsible for one of the first impressions a patient will have of Billings Clinic. Incumbent will provide education both verbally and via mail in an effort to manage the patient and/or family member’s expectations as a patient of our facility. New and some established patients for both clinic and hospital services will be contacted to obtain all patient and guarantor information, insurance information including any information related to accident insurance, etc. as well as additional contact information. All regulatory requirements as to determination of primary and secondary carrier status will be collected. Staff will inform patient/family member of insurance billing processes as well as payment expectations. Payment policies will be reviewed as well as any need for co-payment and/or coinsurance/deposit requirements. An explanation of what the patient can expect at check-in will be provided as well as information regarding parking, valet services, etc. Patients will be provided with a customized new patient welcome packet including their scheduling itinerary and way finding materials. Through the conversations during registration and demographic information collection, staff will provide patients with information regarding the need to contact Financial Representatives in reference to financial assistance and/or payment arrangements. Addresses will be verified electronically by staff members.

ESSENTIAL JOB FUNCTIONS

• GENERAL

Supports and models behaviors consistent with Billings Clinic’s mission, vision, values, code of business conduct and service expectations. Meets all mandatory organizational and departmental requirements. Maintains competency in all organizational, departmental and outside agency standards as it relates to the environment, employee, patient safety or job performance

Provides first impression of Billings Clinic to patients and family members. Focus on patient service is first and foremost.

Validates insurance entries using Intellisource software, commercial web site, or calling insurance company and analyzes electronic/verbal responses ensuring appropriate set-ups dependent upon State where services are being rendered

Coordinates with patients, internal and external providers, nursing staff to ensure Medicaid Passport and other authorizations for referrals required by insurance carriers are obtained and entered onto specifically approved encounters within the revenue cycle system.

Schedules and coordinates appointments in a manner that meets the patient’s needs and is in keeping with each individual provider’s scheduling protocols for the various appointment types, lengths of appointments and any pre-appointment requirements as outlined by the providers.

Review and analyzes AccuReg edits completes corrections in accordance with AccuReg worklist daily.

Consistently uses searching techniques within the Registration system to identify existing Billings Clinic health information record for additional updating.

Accurately obtains all patient, guarantors, primary, secondary and tertiary insurance information from patients and verifies patient/guarantor primary residence address as well as insurance eligibility and co-pay requirements on-line. If unavailable on-line, contact insurance carrier via phone to verify all information. Familiarizes self in various insurance cards and identification to assist patient in providing accurate information.

Participates in quarterly assessments in accordance with policies and procedures.

Reviews, analyzes and interprets information obtained to determine regulatory requirements that may exist including completion of MSPs, gathering of third party payors in relation to accidents, etc. Maintains this knowledge for both a clinic and hospital setting.

Uses processes and information to manage a patient’s expectations for parking, check-in process, way finding, insurance billing turnaround times, etc. Prints patient’s custom schedule itinerary, way finding tools and department specific information along with new patient welcome packet (if needed) and mails to patient.

Discusses Billings Clinic expectations for payment of services by supplying patient with verbal explanation of our payment policies to include co-pays, coinsurances, and/or deposits to be made at the time of service in conjunction with Billings Clinic policies and procedures.

Provides assistance in ensuring patients are directed to the appropriate resources within the organization if questions arise as to the patient’s ability to pay. Provides patients with financial assistance applications if appropriate.

Ensures all work lists are completed within guidelines and provides appropriate hand-off information to others to ensure all patients are contacted.

Performs other duties as assigned or needed to meet the needs of the department/organization.

• Additional Essential Functions for Level II (all of the above, plus)

Cross trained to work in 3 areas in addition to primary work site. Works in cross trained area at least once per quarter for 6-8 hour shift.

Calculates out-of-pocket expenses for pre-paid services.

• Additional Essential Functions for Level III (all of the above, plus #13, plus)

Provides orientation/training and preceptor mentoring for all new and current department staff. Services as a resource and role model in implementation of professional practice.

Cross-trained to work in 4 areas in addition to primary work site. Works in cross-trained area at least once per quarter for 6-8 hour shift. (Education, Cross-Training, Pre-Access Level III)

Works within the Cirius Report and determines correct course of action to resolve errors. (IS, Reporting, Cirius Report)

Perform system testing of new software products and make recommendations regarding issues that are found. (Information Systems, Testing, New Software Testing)

Essential Functions Disclaimer

Supports and models behaviors consistent with Billings Clinic’s mission, vision, values, code of business conduct and service expectations. Meets all mandatory organizational and departmental requirements. Maintains competency in all organizational, departmental and outside agency standards as it relates to the environment, employee, patient safety or job performance.

Performs all other duties as assigned or as needed to meet the needs of the department/organization.

Department or Level Specific Duties and Responsibilities

• Minimum Qualifications

• Experience

Six (6) months experience at Billings Clinic preferred

Prior experience in a customer service related field preferred; health care experience is desirable

• Cross-Training

• Cross-Training on Information/ SPECIFIC Systems

• Knowledge

Entry level position requires a minimum of 6 months up to 1 year of training and experience to gain proficiency in performing on-line registrations gathering demographic and financial information, via the practice management systems

• Analytical Skills

Ability to analyze basic customer inquiries and determine appropriate action in conjunction with the Lead or Supervisory staff

Utilizes Service Recovery when appropriate.

• Independent Judgement

Work is performed in accordance with established policies, procedures and regulatory requirements

Ability to determine proper procedures for resolving various basic to semi-complex problems with minimal supervision

• Interpersonal Skills

Ability to incorporate population specific needs into all aspects of the job

Ability to deal with difficult situations in a mature and professional manner

Ability to discuss financial matters with patients and families in a professional manner while maintaining fiscal perspective

• Service Recovery

• Education

High school graduate or equivalent

Some college or healthcare focused classes preferred such as medical terminology, medical office practices, etc.

Must complete all Level I learning requirements within 12 months of being hired.

• Project Management

• Leadership

• Supervision of Others

• Process Improvement / Quality Assurance /Risk Management

• Fiscal Responsibility

• On-Call Responsibility

• Technical Skills

• Study Assignments

• On-call Responsibility

• Information Systems

• Project Management /Requirements gathering and analysis Skills

• Resource

• Organizational Skills

• Community/Patient Education

• Professional Affiliations

• Overall Performance

• Duties

• Patient Care

• USP-797 Media Fill Testing, Environmental Sampling & End Product Testing Requirements

• Promotional Guidelines

• Essential Functions

• Service/Sales Time Allocations

• Pay Plan Components

• Specimen Examination and Submission Authorization

• Research or Process Improvement, Committee or Council Participation

• Criteria/Role/Activity

KNOWLEDGE OF / SKILLS / ABILITIES / COMPLEXITIES AND DIFFICULTIES

Disclaimer

Billings Clinic policy and procedures, both organizational and departmental

Personal computers, hardware and software

Billings Clinic Code of Conduct

Billings Clinic’s Compliance and Integrity Program

HIPAA and confidentiality requirements

Patient’s rights

Customer service techniques and Personal Service Excellence (PSE)

Knowledge, Skills and Abilities

• Mid-range computer systems

• HIPAA and confidentiality requirements

• NOPP Rights

• Patient’s/resident’s rights

• Practice management

• Third party insurance billing requirements and regulations and collection policies/practices

• HMO and PPO practices

• Office procedures

• Billings Clinic programs and services and in-take process for a variety of departments/services

• Concierge and guest services within the community

• Community resources

• USPS address regulations

• Techniques and use of a variety of address verification tools.

• Telephone etiquette

• Fully understands the clinical ramifications of producing duplicate registrations in relation to EMR

• Fully understands various insurance payers’ rules, guidelines and set-ups for services rendered in Montana, Wyoming, North Dakota, and any State where Billings Clinic providers Outreach Services.

• Encounter types, nurse ambulatories and how to select them appropriately based on the services being rendered, place of service and State where services will be rendered.

• Ability to select appropriate Registration Conversations within ADT system based on type of service, payer of service, professional, technical or combined charges and State in which services will be rendered.

• Fully understands Revenue Cycle and their role in initiating medical record, accurate statement and claim billing information

• Working knowledge of Medicaid Passport program and authorization requirements.

• Ability to analyze various insurance payers’ electronic verification response for Montana, Wyoming and State where Billings Clinic provides Outreach Services.

• Ability to read, analyze and make appropriate corrections to registrations using AccuReg registration auditing software and worklist.

• Ability to learn and operate multiple software packages used in Access Department including:

Cerner

Intellsource/OneSource

AccuReg

Web based insurance verifications

• Professional communication skills, both verbal and written

• Basic computer skills

• Understanding the interaction between multiple software systems

• Analytical and critical thinking to assist with problem avoidance/resolution and process improvement

• Time management, organization, and prioritization

• Basic typing

• Basic 10-key

• Interpersonal relationships and conflict resolution

• Discuss financial needs with patient and family members as appropriate

• Incorporate population specific needs into all aspects of communication and patient care

• Communicate clearly and effectively, both verbal and written

• Establish and maintain collaborative relationships

• Maintain flexibility to adapt to a variety of work load assignments

• Work effectively in a team environment

• Work independently with minimal supervision

• Work with frequent interruptions and competing priorities

• Respond calmly and effectively in emergent situations

• Operate required office machines

• Must be able to handle multiple tasks at one time

• Maintain composure in a position that has considerable deadlines, customer contact, and high volume

• Be flexible to facilitate change

• Make a positive effect on the Patient’s Experience

• Accuracy and data collection is critical in obtaining correct reimbursement for services

• Clerical errors could result in inaccurate patient records or changes which could result in a loss of revenue, physician and/or patient complaints. Creation of duplicate records can result in clinical staff’s inability to take full advantage of multi-specialty, integrated healthcare model.

• Registration errors can result in incorrect identification of the patient resulting in a provider using an erroneous or partial EMR when rendering care, ordering tests or prescribing medications and pharmaceuticals resulting in patient safety and risk management issues.

• Registrations errors can result in erroneous guarantor and/or financial information necessary to facilitate billing and collection procedures resulting in loss of reimbursement, HIPPA violations and patient satisfaction issues and well as non-value added work to make corrections.

• Payment posting errors can result in patient dissatisfaction, desire to no longer pay at the time of service or the erroneous placement of an account with a collection agency or for bad debt wire-off.

• Inappropriate scheduling practices can result in loss of productivity, patient satisfaction issues and poor Day in A/R and denial results.

• Position requires highest degree of integrity and confidentiality due to sensitive nature of information handled; failure to maintain patient confidentiality could result in legal action and patient satisfaction issues. MINIMUM QUALIFICATIONS

Education

Minimum High School or GED High school graduate or equivalent

Preferred Other Some college or healthcare focused classes preferred such as medical terminology, medical office practices, etc.

• Demonstrated excellence in customer service skills

• Or an equivalent combination of education and experience relating to the above tasks, knowledge, skills and abilities will be considered

Minimum Qualifications Disclaimer

Or an equivalent combination of education and experience relating to the above tasks, knowledge, skills and abilities will be considered

Condition Comments

Office environment: indoors, may be in office or cubical, moderate temperature, Lighting: is suitable and efficient and natural so far is reasonably practical. Emergency lighting is provided where lighting failure would cause danger. Water and restrooms are within short moving distance from workstation. office may contain contains furniture and equipment needed to conduct common business activities. These items include desks, chairs, cubicle walls, phone systems and cords, fax machines, copiers, conference room tables, computer systems and file cabinets.

Billings Clinic is a community-owned, not-for-profit health care organization in Billings, Montana with approximately 4,000 employees, including over 400 physicians and advanced practitioners. Our integrated organization consists of a multi-specialty group practice and a 304-bed hospital. Learn more about Billings Clinic (https://www.billingsclinic.com/about-us/) (our organization, history, mission, leadership and regional locations) and how we are recognized nationally for our exceptional quality (https://www.billingsclinic.com/quality-safety/) .

Billings Clinic is comm itted to the principles of Equal Employment Opportunity. All policies and processes are designed toward achieving fair and equitable treatment of all employees and job applicants. Employees are encouraged to discuss any concerns they have in this regard with their immediate supervisor and/or the Vice President People Resources. All employees and job applicants will be provided the same treatment in all aspects of the employment relationship, regardless of race, color, creed, religion, national origin, gender, gender identity, sexual orientation, age, marital status, genetic information or disability.

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