The Pre Access Specialist I is responsible for accurate and complete insurance verification, authorization, and complete pre-registration of all scheduled clinic visits and office based procedures. The position works within the EMR using an automated insurance verification tool along with payer websites and documents within the EMR.
- Family-Centered care that focuses on the need of the child first and values the family as an important member of the care team
- Excellence in clinical care, service and communication
- Collaborative within our institution and with others who share our mission and goals
- Leadership that set the standard for pediatric health care today and innovations of the future
- Accountability to our patients, community and each other for providing the best in the most cost-effective way.
- Contacts the patient's parent/responsible party by phone and obtains all current demographic and insurance and employer information, making updates and creating accounts in the EMR system, as appropriate.
- Courteously answers the telephone and answers all questions in a timely manner. Refers uninsured and underinsured patients to the Financial Counselor via phone transfer and/or work queue assignment.
- Maintains a positive working relationship with patients/guarantors, insurance companies, government entities, clinical personnel, co-workers and management to promote teamwork, cooperation and a positive public image for PCH.
- Notifies the patient/guarantor of any applicable deductible, co-pay, lifetime maximum, pre-existing condition restrictions, previous unpaid liabilities, and other out-of-pocket expenses and request payment.
- Obtains all necessary authorizations for scheduled professional and hospital procedures and office visits and accurately documents all information in the appropriate fields and/or account notes.
- Organizes, prioritizes and reviews daily work activity to ensure that complete, accurate and compliant pre-registration has been performed.
- Participates in a variety of unit and hospital educational programs to maintain current skill and competency levels.
- Verifies insurance benefits using an automated verification solution tool, insurance carrier websites, or by phone, and accurately documents all information in the appropriate fields and/or account notes.
- Performs miscellaneous job related duties as requested.