The Lead Pre Access Specialists primary purpose is to oversee the Pre Access staff and process. This position reports to the Pre Access Supervisor. This position will also be responsible for the accurate and complete pre-registration, insurance verification and authorization of scheduled professional and hospital services across all services. The lead is expected to have an understanding of various divisions and protocols for each division.
- 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.
- This position oversees assigned Pre Access Specialists working directly and collaboratively with manager, supervisors and staff to provide a high level of satisfaction with patients and families utilizing PCH services.
- Works directly and collaboratively with manager, supervisors, staff, and clinical partners to provide best practice for verifying insurance coverage, obtaining authorization for all scheduled professional and hospital services to ensure a high-level of customer satisfaction. Prepares reports that drive work flow within the department and leadership reports as needed. Organizes, prioritizes and reviews daily work activity to ensure that complete, accurate, and compliant insurance verification, authorization, and Pre-Registration has been performed.
Financially clears patients for upcoming services.
- Verifies insurance benefits using an automated verification tool, insurance carrier websites, or by phone. Obtains all necessary authorizations for scheduled professional and hospital procedures and clinic visits. Accurately documents all information in the appropriate fields and/or account notes. Contacts the patient/guarantor and obtains all current demographics including insurance making updates and creating accounts in the EMR if appropriate. Notifies the patient/guarantor of an applicable deductible, copay, annual maximum and other out of pocket expenses and requests payment.
- Proactively researches and trends denials, staff QA, and process improvement related to Pre Access to include changes to hospital-system, best practice in process of Pre Access Accuracy, efficiency and overall patient, provider, and staff satisfaction. Assists Trainer in hand offs and Service Matter Expert training of new and existing staff.
Maintains Proficiencies/Seeks Education
- Participates in a variety of unit, hospital, and/or outside agency education, when approved, programs to maintain and enhance current skills and competency levels.
- Performs miscellaneous job related duties as requested.