The Pre-Access Specialist is responsible for the accurate and complete pre-registration, insurance verification and authorization of scheduled professional and hospital services.
- 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.