Patient Access Quality Specialist

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.

The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time).

Pay Range:

$21.76 - $28.28

Scheduled Weekly Hours:

40

Position Overview

SUMMARY (Basic Purpose of the Job):

Provides technical and analytical support for Patient Access registration analysis and evaluation in performance improvement process. Performs chart review in identifying if variation from quality of registration exists. Monitors patient registrations for accuracy, compliance, and responsibility.

MINIMUM REQUIREMENTS:

Education: High school diploma or equivalent.

Experience: Three years Patient Access department experience.

Knowledge and Skills: Ability to effectively communicate information and respond to questions in person-to-person and small group situations with customers, clients, general public and other employees of the organization.

Special Training: Excellent understanding of insurance concepts and health plan policies. Knowledge in all areas of hospital registration and authorizations.

Mental, Behavioral and Emotional Abilities: Ability to deal with problems involving several known variables in situations of a routine nature.

ESSENTIAL FUNCTIONS:

• Comprehends registration requirements and applies it during chart review. Perform chart review to identify if variation from quality registrations exists, and to determine the need for process improvement. Identify concerns and make recommendations for review to improve processes. Communicate findings as appropriate to department management involved. Reports discrepancies to supervisor/manager to ensure corrective action is taken in a timely manner.

• Maintains complete knowledge of registration system and department operational procedures and training guidelines to identify and have the ability to audit charts for accurate demographic, diagnosis, and insurance information for all registrations.

• Maintains complete knowledge and understanding of department procedure to guarantee proper registrations for Trauma, Doe, Pre-hospital stroke, Neuro, Cardiac Cath registration, downtime and disaster processes.

• Provides staff coverage as needed. Assists with development and implementation of new or improved processes. Maintains up to date knowledge with Insurance matrix, registration compliance, insurance applications, other systems utilized by Patient Access.

• Utilizes excellent communication skills, ability to communicate, and obtain additional patient information, scripts, referrals, authorization from physicians and other customers.

• Possesses proficiency with all insurance plans and payer codes. Ability to identify payment source and to secure all information required to insure a billable and collectable account and avoid penalties, denials prior to the bill dropping.

• Maintains thorough understanding of payor requirements for authorization, pre-authorization, referrals, coordination of benefits forms, and in-network verification according to department procedures and the Insurance Card Database and Insurance Verification guidelines. Performs verification of benefits either electronically or by telephone according to department procedures and guidelines. Identifies and obtains required precertification, authorizations and/or referrals and audits all information in the appropriate registration and billing system.

• Possesses ability to understand and use audit reports for missing vital billing information.

• Reviews coordination of benefits, and Medicare secondary payor guidelines to determine primary and secondary payer status, Advance Beneficiary Notice, Advance Directives, and P