Patient Access Specialist - Remote

Tufts Medicine - Lawrence, MA

Full-time - Entry Level

Remote - Lawrence, MA

Ambulatory Health Care Services

About the position

The Patient Access Specialist role is focused on revenue cycle operations, including billing, collections, and payment processing. This position involves performing administrative and financial-clearance duties to facilitate the procurement of clinical services by patients, ensuring proper scheduling and handling of referrals. The specialist will also be responsible for obtaining complex precertification and verification of benefits with insurance carriers for various medical services, while collaborating with other departments to address financial concerns and ensure proper authorization for services.

Responsibilities

• Contact insurance companies to obtain verification of insurance, eligibility, and level of benefits.
• Enter benefit information into hospital computer systems.
• Contact patients for updates of financial and demographic information and enter data into hospital systems.
• Obtain financial data from various sources including payers and utilize computer systems for eligibility checks.
• Arrange coordination of benefits when multiple insurance carriers are involved.
• Update financial/insurance plan codes in hospital systems according to eligibility responses.
• Seek clinical approval of admission (precertification) for surgeries and procedures, entering information into systems.
• Identify non-covered services by insurance policies and refer financial risk concerns to leadership.
• Collaborate with Financial Coordination colleagues regarding financial risk concerns for resolution.
• Obtain clinical documentation required by insurance payers for elective services and submit timely.
• Monitor case statuses and communicate/document pending and approved statuses.
• Identify denied claims and work with department leaders on appeals and peer-to-peer workflows.
• Monitor productivity and quality of workflow, reaching goals.
• Act as a resource for other departments regarding precertification policies and account resolutions.
• Communicate status of financially at-risk cases to team members and leadership.
• Maintain collaborative relationships with peers to achieve goals and foster a positive work environment.
• Work closely with Case Management to confirm level of care changes and communicate with payers.
• Learn workflow changes in real-time and assist in training new team members.
• Work with Revenue Cycle colleagues to analyze complex denials and appeal them timely.
• Act as a resource for the team, sharing updates and participating in meetings.
• Assist Manager with coverage in supervisor's absence.

Requirements

• Four (4) years of related experience in a hospital, physician's office, or financial setting.
• Pre-certification experience.

Nice-to-haves

• Five (5) years of related experience in a hospital, physician's office, or financial setting.
• Associate's degree.

Benefits

• Health insurance
• Dental insurance
• Vision insurance
• 401k
• Paid holidays
• Flexible scheduling
• Professional development opportunities