Job Details

Title: Patient Access Specialist

Job Summary:

Under the supervision of the Patient Access Supervisor (PAS), the Patient Access Specialist (PAS) of Omni Family Health (Omni) provides [insert language] to a growing network of state-of-the-art health centers serving California's Central Valley. As a member of the organization's Finance Department, the PAS is responsible for Facilitates timely access to care by ensuring patient eligibility and benefits are verified prior to services. Works with health plans to obtain prior authorization for services when required. Performs Commercial, Medicare and Managed Care billing and research within timeframe and benchmark expectation set by Omni Family Health Management. Responsible correcting claim edit and successfully processing a clean claim. Has knowledge of commonly used medical terms and billing procedures.

Job Duties:

1. Responsible for verifying patient benefit eligibility for all treatment/procedures . Obtains pre-authorization, if required.

2. Verifies accuracy of patient information, such as demographic data, and applies any necessary updates or corrections in order to achieve a clean claim submission.

3. Resolves any issues or discrepancies that arise during the verification process. Refers more complex issues to management.

4. Review RTS manager daily to correct errors identified prior to patient visit.

5. Research documentation with physician and/or other medical personnel if clarification is required.

6. Ensures the department provides cohesive support to the mission, vision, and core values while delivering superior customer service.

7. Works closely with all corporate branches, divisions, and/or departments in accordance with Omni's policies and procedures.

8. Other duties and/or responsibilities as the PAS may be assigned from time to time.

9. Some travel may be required.

Additional Duties:

1. Health Insurance Portability and Accountability Act (HIPAA) Compliance: Responsible for maintaining abreast of and in compliance with all HIPAA regulations and requirements.

2. Compliance: Ensure compliance with all local, state, and federal regulations.

3. Quality Assurance/Quality Improvement (QA/QI): Participate as required in QA/QI activities and contribute towards the overall quality improvement initiatives of the organization.

4. Information Technology (IT): May be required to learn and use the electronic health record and its components as required by the job functions and highlighted in the policies and procedures. These components include NextGen, Practice Management System (PMS), Quality Systems Inc. (QSI), and other electronic features as they are developed and implemented, as applicable to work environment.

5. Patient Centered Medical Home (PCMH): All employees will participate in PCMH at Omni Family Health.

6. Audits: Contributes to required Health Resources and Services Administration (HRSA), Operational Site Visit (OSV), The Joint Commission (JC), and other audit events.

Qualifications, Education, and Experience:

1. High School Diploma or GED certificate.

2. Two (2) years of experience in billing and account receivables in a healthcare setting, preferably a Federally Qualified Health Center (FQHC).

3. General knowledge of coding rules, regulations, and third party payer requirements preferred.

Skills/Competencies:

1. Ability to work under pressure.

2. Ability to handle multi-functions.

3. Understanding of community based organizations.

4. Ability to demonstrate effective communication skills (verbal, nonverbal, written) with the medical/dental staff and Office Managers.

5. Ability to work proficiently and efficiently on a timely manner.

6. Ability to problem-solve and make decisions consistent with organizational policies and procedures

7. Able to work independently, demonstrating effective initiative, follow-through, organizational skills

8. Knowledge of all payer codes.

9. Knowledge of all programs offered by OFH.

10. Must be alert and respect confidentiality of information of all types "general personnel, and/or patient related information."

11. Promotes and believes in Omni's mission statement.

12. Ability to relate to the public regardless of race, ethnicity, religion, age, sex, disability, or economic status.

Responsible To: Billing Supervisor