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Position Details

Department: Pre Access Services
Category: Patient Access
Location: Phoenix
Posting #: 468889
Date Posted: 8/27/2019
Employee Type: Regular

Position Summary

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.

PCH Values

  • 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.

Position Duties

  1. Oversees Staff
    • 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.
  2. Oversees Process
    • 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.
  3. 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.
  4. Provides Training
    • 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.
  5. 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.
  6. Performs miscellaneous job related duties as requested.

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Position Qualifications

Please review the following qualifications and specify whether you meet each of the requirements listed.
Do you meet this requirement?
Education
1. Associates Degree in health care, business or related field OR the equivalent combination of education and experience. Required
Do you meet this requirement?
Experience
1. Minimum of 3 years experience requesting Professional/Clinical or Hospital authorizations with at least one year in Pre-Registration. Required
2. Experience with EMR, document management/imaging system, and Payer Websites Platform. Required
3. Minimum of 2 years experience in Customer Service. Required
4. Knowledge base and experience with CPT Codes, J Codes, and ICD Codes. Required
5. 1 year experience in Leadership role. Preferred
Do you meet this requirement?
Special Skills
1. Must be able to work independently and ability to work effectively in a high volume, fast paced environment with changing priorities. Required
2. Must possess customer focused attitude and professional demeanor. Required
3. Excellent communication skills (written and oral). Required
4. Knowledge of Medical Terminology and an understanding of HIPAA Privacy Laws Required
5. Analytical skills with strong attention to detail and a high degree of accuracy. Preferred
6. Proficiency of MS Office Word, Excel and database systems. Preferred
7. Ability to motivate and lead a team to meeting goals. Required
8. Bilingual (Spanish) Preferred
Physical Requirements & Occupational Exposure/Risk Potential
1. Physical Requirement - Climbing Occasionally
2. Physical Requirement - Feeling (sensing textures and temperatures) Occasionally
3. Physical Requirement - Fine Motor Skills (pinching, gripping, etc) Occasionally
4. Physical Requirement - Hearing Frequently
5. Physical Requirement - Pushing/pulling Occasionally
6. Physical Requirement - Reaching Occasionally
7. Physical Requirement - Sitting Constantly
8. Physical Requirement - Standing Occasionally
9. Physical Requirement - Stooping/crouching/kneeling/crawling Occasionally
10. Physical Requirement - Talking Constantly
11. Physical Requirement - Tasting/smelling Occasionally
12. Physical Requirement - Walking Occasionally
13. Physical Requirement - Near Vision Frequently
14. Physical Requirement - Far Vision Frequently
15. Physical Requirement - Color Discrimination Occasionally
16. Physical Requirement - Use of keyboard, mouse and/or computer equipment Constantly
17. Physical Requirement - Lift up to 35 pounds without assistance Occasionally
18. Physical Requirement - Lift more than 35 pounds without assistance Occasionally
19. Occupational Exposure/Risk Potential - Inside office environment Applicable
internal/external
I have reviewed the qualifications, physical requirements and occupational exposure/risk potential for this position and wish to apply