Patient Access Coordinator
1 week ago
Job Summary
The Patient Access Specialist will be responsible for delivering exceptional customer service to all patients and families. This role requires a strong commitment to service excellence and the ability to work effectively in a fast-paced environment.
Key Responsibilities
- Obtain demographic, insurance, and medical information to ensure accurate and complete registration.
- Perform insurance verification, data collection, and documentation.
- Determine medical necessity for services based on established medical criteria.
- Identify patient financial responsibilities and collect applicable monies.
- Act as liaison to all internal and external customers to facilitate access to hospital services.
- Secure all necessary documentation to register the patient's visit.
- Review all documentation to ensure coding by provider is supported and accurate.
- Apply all coding rules and use of CPT and ICD 10 codes and appropriate use of modifiers.
- Assist manager in educating physicians and staff in requirements of documentation for proper reimbursement.
- Assist in conducting internal audits of patient charges and corresponding documentation, reports, and tracks on a monthly basis.
- Submit claims and work rejections for claims submission, daily.
- Check for data errors and use them as examples for educating team members.
- Determine problems that resulted in a rejected claim, resolve, advise on procedural changes to implement, and prevent further such rejects.
- Resubmit/re-file, print records as needed to appeal rejected claims, as is necessary.
- Check coding and post charges.
- Adhere to contractual requirements of Medicare, Medicaid, and managed care plans.
- Scrubs and reviews charges before claims are submitted.
- Reviews surgical claims and post-op visits to ensure we capture a full reimbursement.
- Run daily update and insurance exception reports.
- Review and correct, re-scrub rejected claims.
Requirements
- High School Graduate or Equivalent, Billing and Coding Certification preferred.
- Experience required in using EMR systems, insurance verification, eligibility, and electronic billing.
- Requires general and specific knowledge of health insurance plans and interpretation of health insurance benefits.
- Extensive knowledge of current billing and coding rules and regulations and use of CPT & ICD 10 codes including appropriate modifiers for Radiation Oncology, Infusion and Oncology Surgery.
- Ability to read, understand, and adhere to CMS & NCCN guidelines and compliance.
- Ability to maintain confidentiality.
- Experience in a customer support role.
- Medical terminology knowledge.
- Proficient skills in computer applications such as Microsoft Office.
- Ability to set priorities and manage time effectively.
- Flexible, service-oriented, and dedicated.
- Exceptional communication skills both verbally and in writing.
- Superior organizational skills, attention to detail, and able to multi-task.
- Strong interpersonal skills, listening, and ability to carefully follow directions.
About Us
Jupiter Medical Center is the leading destination for world-class healthcare in Palm Beach County and the greater Treasure Coast. Our outstanding physicians, state-of-the-art facilities, innovative techniques, and commitment to serving the community enable us to meet a broad range of patient needs. We are proud to be the only hospital in Palm Beach, Martin, St. Lucie, and Indian River counties to receive a 4-star quality and safety rating from the Centers for Medicare & Medicaid Services (CMS).
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