Health Access Rep - Lead

Work Shift:

Day (United States of America)

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 advance technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made up of more than 250 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Position Overview:

SUMMARY (Basic Purpose of the Job)

Functions as a super user to insure department compliance with system and operational changes and assists in training to support ongoing staff education and development. Applies financial screening guidelines to insure collectable accounts and functions as a resource to staff. Communicates effectively and works cooperatively with others. Has respect for and understanding of other registration disciplines. Utilizes standards, guidelines, and written procedures for performing registration functions.

MINIMUM REQUIREMENTS

Education:

High school diploma or equivalency.

Experience:

One year of Health Access experience. Knowledge of all Capital Health departments required.

Other Credentials:

Knowledge and Skills:

Health Access Representative productivity exceeds 90% with less than 10% error rate. Strong customer service skills.

Special Training:

Basic computer skills. Health insurance knowledge, prior authorizations knowledge, and scheduling experience required.

Mental, Behavioral and Emotional Abilities:

Possesses ability to work independently and as a team member.

Usual Work Day:

8 Hours  

Reporting Relationships

Does this position formally supervise employees? No

ESSENTIAL FUNCTIONS

• Assists in training, problem solving, and quality review with subordinate health access representatives. Assigns duties to registrars as directed by team leader or supervisor.
• Assumes on-call rotation -Provides coverage in working area as required.
• Follows compliance with computer system procedures, department procedures, and training guidelines to accurately complete each registration. Serves as a resource for company protocols.
• Audits charts for accurate demographics, Medicare compliance, authorizations and referrals, necessary signatures, and completion of forms and charts.
• Complies with department procedures and regulatory guidelines for Medicare Secondary Payer, Advance Beneficiary Notice, Advance Directives, Patients Rights, and the Interpreter flag as measured by quality assurance and observation.
• Follows and monitors staff compliance with following payer requirements for authorization, pre-authorization, referrals, coordination of benefits forms, and in-network verification according to Insurance Card Database, and Insurance Verification guidelines.
• Audits charts for final billing. Ensures accurate demographics, authorizations or referrals, necessary signatures, and completion of forms and charts.
• Follows Financial Screening and Self Pay procedure regarding referrals to Medicaid and charity.
• Assists with training and education of patient access staff.
• Communicates effectively with Health Access team members and is open to feedback and suggestions in order to identify opportunities for improvement.
• Identifies and seeks out members of the registration department as a resource to increase knowledge and seek validation of department guidelines and procedures.
• Identifies unit and department goals and supports the culture of organization.
• Supports department performance improvement initiatives. Initiates ideas to meet department goals.
• Attends all mandatory department meetings.
• Follows patient identification policy.
• Serves as a resource for Health Access department. Leads department through daily workload and divides work as needed.
• Acts as a liaison for physician office and ancillary departments as needed.

Offers are contingent upon successful completion of our onboarding process and pre-employment physical.  Capital Health will require all applicants (including contractors, travelers and consultants) to have an annual flu vaccine prior to start date, with the exception of individuals with medical and religious exemptions.

"Company will never ask candidates for social security numbers or date of birth during application phase. If you are asked for this information online, you may be a target for identity theft."