Patient Financial Access Specialist - Op

Yale New Haven Health
medical insurance
United States, Connecticut, Wallingford
Nov 08, 2024
Overview To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day. The Patient Financial Access Specialist - OP is responsible for all the Patient Financial Access Facilitator functions and responsibilities as well as provides support with complex scheduling in more than one outpatient service area. Utilizing effective communication and effective use of technology, performs a variety of functions including accurate patient identification while adhering to Red Flag procedures to ensure patient safety. Obtains and updates the patient's demographic and financial information utilizing multiple computer systems to assure timely processing of the patient's visit. Functions as the liaison between the physician and the patient in managing appointment and procedure scheduling for both internal and external patient appointments. This individual works closely with patients, physicians and nurse professionals within the clinic setting and is responsible for accurately managing and making decisions related to sequencing of complex procedures, physician appointments, infusion/chemotherapy and other multifaceted services. Communicates directly with the patient and/or the physician office to ensure instructions, preparations or laboratory test requirements prior to the procedure/appointment have been met. Coordinates multiple patient appointments and manages patient and insurance demographics to ensure appropriate reimbursement for services provided. This individual will be responsible for making decisions around exams ordered as they relate to meeting Medical Necessity and follow up with patient and/or physician when a Waiver or ABN is required. Individual is cognizant of imaging and other satellite sites across the System and appropriately aligns appointments with patient locations. A major focus in completing these responsibilities will rely on the individual's attention to detail, specificity and accuracy as it relates to the procedure, the appointment or the chemotherapy, the supporting documentation and an extraordinary level of patient sensitivity and compassion. Position requires the individual to maintain a high awareness of Service Excellence representing "I am YNHH" at all times and in all locations. Performs certain statistical and QA functions. Helps develop new procedures and participates in the planning, implementation, and training of system improvements to enhance the operating functions of the department. EEO/AA/Disability/Veteran Responsibilities 1. Patient Throughput: Ensures all required information obtained from referring physicians and providers in clinical areas are provided to the third party payers to ensure reimbursement for services delivered within the outpatient setting. 1.1 Accurately schedules patient follow-up physician appointments in the appropriate scheduling system using guidelines and requirements identified within the system. 2. Insurance: Demonstrates a solid understanding of the various insurance carriers' options and completes insurance entry accurately, satisfying billing requirements to ensure a payable account. 2.1 Exhibits a comprehensive understanding of the online eligibility and insurance website systems including understanding patient's eligibility, determining benefits and co-pay amount due. Documents appropriate computer system according to departmental policies. 3. Complex Appointment Scheduling: Coordinates and supports tasks related to patient appointment scheduling. 3.1 Maintains a strong working knowledge of the Epic system with the ability to schedule complex and time sensitive appointment types. 4. Resource Management/Quality Assurance (QA): In collaboration with Supervisor/Manager, provides support in the other outpatient service department and routinely provides coverage as necessary to maintain skill sets. 4.1 Independently optimizes time related to patient appointment scheduling. 5. Customer Service: Provides service excellence as outlined in the Health System Standards of Professional Behavior. 5.1 Ensures smooth functioning of all processes in order to guarantee a positive patient experience by acknowledging and receiving patients and visitors to the department following the YNHHS Standards of Professional Behavior. 6. Template Management - Addendum: Works with the clinical staff to maintain Epic Templates for various locations. 6.1 Meets with clinical team to plan and create scheduling templates for various disciplines in the Epic System. 7. Performs other duties as assigned by Management. 7.1 As needed, reviews and updates all training materials and provides training to other staff members. Qualifications EDUCATION High school diploma or GED required. Associate degree preferred. EXPERIENCE Two (2) to three (3) years' work experience in a customer service environment preferably in hospital/physician office with emphasis on registration, scheduling, and all aspects of medical insurance and eligibility requirements preferred. SPECIAL SKILLS Self-directed, well organized and exhibiting team oriented skills with the ability and desire to educate and advocate for patients and their families. Must be able to multitask and reprioritize in response to fluctuations in volume. Strong interpersonal skills and ability to build rapport with a wide variety of individuals including clinical staff in order to meet the patient's needs. Excellent investigative, critical thinking and problem solving skills. Intermediate computer skills and the ability to adapt to various programs/systems. Demonstrated proficiency in understanding registration work queues that affect workflow. Must be able to provide training or in-service to other staff and areas within the department and Hospital. Consistently demonstrates effective written and oral communication skills in coordination with the Standards of Professional Behavior with the ability to communicate complex requirements across clinical and financial disciplines. YNHHS Requisition ID 131781