Patient Access Coordinator, Outpatient Physical Therapy

Position: Patient Access Coordinator, Outpatient Physical Therapy       

Location: Boston, MA (South Bay)

Schedule: 40 hours per week, Mon - Thur: 10:00a - 6:30p, Fri: 8:00a - 4:30p

POSITION SUMMARY:

Serves as a liaison for patients in all communications regarding care rendered in the assigned department.  Greets patients and family members; registers patients; answers and directs telephone calls; obtains and verifies insurance information. Schedules appointments, updates dispositions of patients. Serves as the unit's centralized focus of administration, information, and communications during the assigned shift.

JOB RESPONSIBILITIES:

Registration/ Pre-Scheduling:

• Interview all patients, or referring physicians to obtain all financial and demographic information required for reimbursement for services rendered.
• Enters patient registration data into appropriate systems according to established procedures to ensure proper reimbursement from third party payers and patients.
• Verifies third-party insurance coverage for prospective patients and verifies day of service eligibility for appropriate insurance.
• Directs patients with financial concerns and directs them to staff who can assist them in the completion of necessary forms and applications for financial assistance from private and/or public funding. 
• Collects deposits for co-payments, and completes reconciliation process per proper procedures.
• Verifies and updates demographics, insurance and provider information on existing and new patients.
• Assigns medical record numbers to new patients in order to ensure current information in the Master Patient Index (MPI) upon completion of a registration.
• Creates and/or updates occasion of service for all patients.
• Verifies the patient’s insurance benefit and the type of coverage and if prior approval for service is necessary for payment of services rendered.
• Verifies any Workers compensation and/or Motor Vehicle accident related claim information.

Management of Authorization/Referral:

• Works collaboratively with primary care practices, specialty practices, referring physicians, primary care physicians, insurance carriers patients and any other parties to ensure that required managed care referrals and prior authorizations are obtained and appropriately recorded for patient appointments/visits prior to scheduled patient visits or retro-actively if not in place at the time of the appointment/visit.  Ensure that approval numbers are appropriately linked to the relevant patient appointment/visit.
• Verifies insurance through eligibility or payer systems
• Routinely produce the appropriate missing referral reports to identify scheduled visits for which a referral is required but is not yet documented.
• When it is determined that a valid referral does not exist, utilize computer-based tools or contact the appropriate party to obtain/generate referral/authorization and related information.  Record the referral/authorization in the practice management system.
• Contact internal and external primary care physicians to obtain referral/authorization numbers. 
• Perform follow-up activities indicated by relevant management reports.
• Review practice management reports and resolve any registration or insurance information in order to complete the managed care referral/authorization.
• Contact patients when information required to obtain referrals or authorizations is not complete.  Serve as a liaison between practices and patients to communicate the status of obtaining referrals and authorizations.
• Communicate with patients regarding their responsibility for contacting insurance carriers in order to update inaccurate information.  Follow-up as necessary to ensure that updates have been completed.
• When an appeal is necessary, write timely appeal letters and send to patients and insurance carriers in accordance with carrier guidelines as required.
• Work collaboratively with the practice to resolve registration and insurance verification issues, to the extent that these unresolved issues impact the ability to obtain a referral.
• Contact patients and providers, to prospectively obtain managed care approvals.  Notify appropriate staff of all patients without required approvals for determination of whether patient will be seen.  Note in appropriate system, any decisions about the status of unapproved patients.
• Mail out managed care referral or authorization letters in accordance with department policies.
• Regularly undergo audits to achieve the req