Pt Financial Access Spec - Op

New Haven, CT
Dec 3, 2018

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Job Description

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.
EEO/AA/Disability/Veteran
Summary:
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.
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.
  • 1.2. Accurately sequences complex procedures across multiple departments/locations.
  • 1.3. Accurately schedules and sequences services for patients who desire to go outside of the Yale New Haven medical system.
  • 1.4. Clearly identifies and communicates dates, times and locations of appointments and procedures with each patient.
  • 1.5. Enters appropriate "addendum" on the order in EMR identifying date and time of the procedure scheduled. Ensures all referrals, pre-authorizations, and pre-certifications are received prior to services being rendered.
  • 1.6. Adheres to state and federal guidelines as it pertains to HIPAA and JCAHO requirements and all federal mandates.
  • 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.
  • 2.2. Informs patients of their financial responsibility as it relates to billing requirements and non-covered balances. Makes all attempts to collect monies due at time of service. When applicable explains the hospital credit policy and determines the need to initiate financial document for reimbursements.
  • 2.3. Processes and reconciles registration edits in a timely efficient manner to ensure timely reimbursement on the patients account.
  • 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.
  • 3.2. Ability to multitask and toggle between systems and resources as necessary to determine status of referrals, schedule appointments and answer/resolve problems for patients, providers and insurers.
  • 3.3. Identifies discrepancies within the systems and reconciles if appropriate and/or reports to the defined IT resources or escalates appropriately.
  • 3.4. Works collaboratively with the Management team to correct any variances that occur within the system to ensure correct data has been captured.
  • 3.5. Ability to operationalize downtime procedures as required.
  • 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.
  • 4.2. Tracks and monitors performance and productivity to ensure patient throughput is not compromised.
  • 4.3. Identifies and offers ways to reconcile when bottlenecks occur within the systems or processes.
  • 4.4. Provides flexibility within schedule to ensure patient and physician's requirements and needs have been met.
  • 4.5. Maintains statistical information and prepares reports as requested.
  • 4.6. Identifies and implements processes that will enhance the scheduling and registration process.
  • 4.7. Participates in designated PFAS workgroups to support team building and communication enhancements within the areas.
  • 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.
  • 5.2. Is prompt, courteous and accurate in advising clinical staff of the patient's arrival working closely to ensure timely patient throughput. Notifies team of experienced delays and keeps patients informed when delays occur.
  • 5.3. Answers telephone by responding no later by the third ring, demonstrating appropriate telephone etiquette guidelines.
  • 5.4. Recognizes when Service Excellence has been compromised and appropriately initiates the Service Recovery Process.
  • 5.5. Follows Department Uniform Policy and Dress code Guidelines related to professional, business attire at all times.
  • 5.6. Utilizes effective communication skills when coordinating work efforts, training, and proposing work flow adjustments and processes
  • 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.
  • 6.2. Uploads accurate templates into Epic.
  • 6.3. Ensures changes to physician calendars and appointments types are updated on a timely basis and uploaded in order for accurate scheduling completion
  • 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.
  • 7.2. Proactively addresses work flow issues in the area to avoid problems or to meet deadlines.
  • 7.3. Demonstrates exceptional problem solving ability and is capable of handling difficult situations without seeking assistance from Supervisor/Manager. Independently addresses complex situations requiring assessment or analysis to identify possible solutions.
  • 7.4. Anticipates possible problems that may arise when making decisions and acts promptly and carefully in a manner appropriate to the situation.
  • 7.5. Ability to assist and act as a resource to other team members with troubleshooting on complex problems and often resolving prior to bringing it to the attention of the Supervisor.
  • 7.6. Independently works on special projects as assigned in the area to address issues and meets goals of the department.
  • 7.7. Participates in ongoing quality improvement efforts of the department, utilizing good problem solving skills and resourcefulness to address and resolve problems.
    Other information:

    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.
    ACCOUNTABILITY:

    Responsible and accountable for effective coordination of complex scheduling and patient appointments across departments/locations and multiple disciplines. Sets priorities and maintains knowledge of all procedures and appointments to be scheduled as they relate to protocol, scheduling accuracy and efficiency and Medical Necessity as identified by the payer. Manages the coordination, accuracy and sequencing of appointments in all scheduling systems within each clinic. Monitors patient throughput in support of patient care to provide appropriate, efficient, and effective patient flow. The individual is accountable for the collaboration of these tasks with the healthcare team as well as identifying any obstacles that impact timeliness of appointment, patient care or potential reimbursement denial. Must be available to work flexible shifts to meet patient needs including off-shift, weekends and holidays as needed.
    COMPLEXITY:

    Capable of balancing appropriate level of intervention and partnering with clinical staff to insure the highest quality of patient care. Must have the ability to communicate complex requirements across clinical and financial disciplines. Exercises independent judgment, critical thinking around decisions that may impact patient throughput, service excellence and patient care. Requires a clear understanding of policies and procedures related to the scheduling and coordination of patient appointments. Utilizes knowledge and experience related to patient diagnosis when scheduling Imaging and /or Chemotherapy appointments and must have a clear understanding of Chemotherapy scheduling guidelines related to how drug is administered. Understands the pre-authorization process and when Waiver/ABN is necessary. Maintains a variety of statistical reports to track quality assurance, customer service and employee productivity.
    PHYSICAL_DEMAND:

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    Job Info

    Job: 3127

    Department: Patient Account Representative
    Category: Finance
    Status: Full Time
    Shift: DAYS
    Hours: 40.00