Patient Access Data Integrity Specialist II

Description

Job Description: To perform timely and accurate patient throughput functions such as financial screening including utilizing systems and other means to verify eligibility, benefits, and medical necessity, obtaining prior authorization, calculating and collecting co-pays and other out-of-pocket- amounts

due from patients, register and schedule patients, checking patients in and out, and generally ensuring data requirements for patient

demographics, insurance coverage and financial clearance are met with a high degree of reliability and the Master Patient Index is properly

maintained at all times. Ensures financial success for University of Mississippi Medical Center through diligent approach to work, attention to

detail, and highly reliable data collection and recording.

Intermediate knowledge of patient throughput workflows and regulations. Proficient in revenue cycle healthcare systems. Ability to maintain

confidentiality. Intellectual capacity to understand and analyze complex payer guidelines and proper patient access regulations.

Demonstrated analytical skills to discover root cause of errors and properly correct. Good verbal and written communication skills. Maintains

professional standards. Effective organizational skills. Basic computer skills, including but not limited to proficiency in Microsoft Word and

Excel, and basic data entry.

Knowledge, Skills and Abilities

• Intermediate knowledge of medical terminology
• Intermediate knowledge of revenue cycle functions
• Ability to pay attention to detail
• Ability to maintain a professional appearance and attitude
• Ability to read, write, type, and follow oral and written directions
• Ability to work independently to effectively and efficiently perform assigned duties
• Good interpersonal communication and organizational skills, and proven ability to work effectively with others

Responsibilities

Duties may include but are not limited to core revenue cycle patient throughput functions such as data entry, registration,

scheduling, prior authorization, benefits screening, real time eligibility verification, collections from patients for out-of-pocket

amounts, and medical necessity checks.

• Maintains strict confidentiality and adheres to all HIPAA guidelines and regulations.
• Focuses daily on complying with policies, processes and department guidelines for assigned revenue cycle duties.
• Responsible for assigning accurate medical record numbers, completing medical necessity/compliance checks, providing proper patient instructions, collecting and properly entering insurance information, collecting payments from patients, and maintaining the integrity of the patient demographics in the system.
• Has an intermediate understanding of payer guidelines, legal and compliance requirements related to patient access; is knowledgeable and proficient with payer websites and other useful resources pertaining to revenue cycle functions.
• Works assigned reports, work-lists, and patient accounts.
• Collaborates with management and co-workers in an open and positive manner.
• Contributes to a positive working environment
• Performs any other assigned duties since the duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time.

Environmental and Physical Demands:

Requires occasional exposure to unpleasant or disagreeable physical environment such as high noise level and exposure to heat and cold,

occasional handling or working with potentially dangerous equipment, occasional working hours beyond regularly scheduled hours,

occasional travelling to offsite locations, no activities subject to significant volume changes of a seasonal/clinical nature, occasional work

produced is subject to precise measures of quantity and quality, occasional bending, occasional lifting/carrying up to 10 pounds, occasional

lifting/carrying up to 25 pounds, occasional lifting/carrying up to 50 pounds, occasional lifting/carrying up to 75 pounds, occasional

lifting/carrying up to100 pounds, no lifting/carrying 100 pounds or more, no climbing, no crawling, occasional crouching/stooping, occasional

driving, occasional kneeling, occasional pushing/pulling, frequent reaching, frequent sitting, frequent standing, occasional twisting, and

frequent walking. (Occasional-up to 20%, frequent-from 21% to 50%, constant-51% or more)

Requirements

Education and Experience:

High school diploma or GED required.

Four (4) or more years of relevant experience in Admissions, Patient Registration, Scheduling,

Insurance Verification, Pre-Registration, Collections, Prior Authorizations, Payor Authorizations and/or Call Center, with a proven track

record of accomplishing high quality work in a professional manner, or two (2) years relevant experience in Admissions, Patient Registration,

Scheduling, Insurance Verification, Pre-Registration, Collections, Prior Authorizations, Payor Authorizations and/or Call Center and hold

certification as a Certified Healthcare Access Associate (CHAA) through National Association of Healthcare Access Management (NAHAM).

Certifications, Licenses or Registration Required: N/A