Patient Access Assistant

Summary

Remote after 90 days in office and KPI has been met. The primary function of this position shall be to coordinate the timely completion, monitoring, and submittal of all incoming pre‑authorizations for diagnostic testing procedures and surgeries. This role will work closely with providers and patients in resolving, documenting, monitoring, and communicating pre‑authorizations for diagnostic testing procedures and surgeries. The employee will validate preauthorization information and complete appeals to insurance companies if a claim is denied related to authorization.

• (35%) Monitor surgical/diagnostic imaging schedules to verify that pre‑authorization is in place and correct in order to receive payment on high dollar accounts. Track incoming pre‑authorizations using the Electronic Medical Record system. Review referrals within the Electronic Medical Record for accurate CPT codes.
• (25%) Work directly with physician offices to ensure authorization for diagnostic testing procedures/surgeries is in place. Provide education and training to physician offices on authorization‑related issues.
• (20%) Provide excellent customer service to patients on the phone and face‑to‑face. Manage difficult situations that arise with the authorization process.
• (20%) Coordinate investigation into denials on a weekly basis and complete retro‑authorization or appeal process. Ensure appeals are submitted in a timely manner via mail, fax, telephone, or electronically.

• Maintain positive relations with all customers, assisting with resolving questions, inquiries and/or issues.
• Lead surgery and high‑dollar imaging denial management for the medical center.
• Operate a computer using MS Office applications such as Word and Excel, as well as vital systems required for registration and insurance verification.
• Deliver non‑coverage paperwork or notification to patients or department leaders when required.
• Knowledge of medical terminology and medical office practices, policies and procedures preferred.
• Work directly with OR lead scheduler or department to ensure scheduled OR/procedure time is utilized for authorized services.
• Perform pre‑registration responsibilities for upcoming surgeries or procedures.
• Other duties as assigned.

High school or GED is required.

• One year medical office experience in a medical center or similar setting preferred.
• Typing skills and basic computer knowledge needed to enter patient information.
• Ability to work independently, demonstrating problem solving, organizational skills, time management and initiative.
• Maintain confidentiality of patient information and data obtained.
• Attend appropriate meetings.
• Ability to multitask and work under pressure of deadlines, changes in schedules and office routines.
• Operate office equipment including computer, printer, photocopier, facsimile machine, multi‑line telephone, calculator.
• Work where employee may be exposed to communicable diseases.
• Excellent phone, listening, and interpersonal skills needed to communicate successfully with individuals and groups.
• Windows PC and Internet experience required.
• Competency in Microsoft Windows required.

• Exposure to stressful situations, including public contact, trauma, grief and death.
• Wear personal protective equipment including latex or appropriate substitute if required.
• Move freely about facility with or without an assistive device; must perform functions of the job as outlined.
• Vision and hearing necessary, with or without assistive device(s).
• Sit/stand/walk for long periods; may require frequent postural changes such as stooping, kneeling or crouching.
• Exposure to blood‑borne pathogens and other potentially infectious material; must follow My Michigan Health blood borne pathogen and TB testing requirements.
• Handle multiple tasks, work independently, regular attendance and ability to stay awake.
• Dexterity for handling, reaching, grasping, fingering and feeling; may require repetition of movements.
• Physical demand level: sedentary. Lift or carry 0‑10 lbs occasionally.

• Not Applicable

• Full‑time

• Administrative
• Hospitals and Health Care