Operations Access Specialist Pathways Post Acute Brain Injury Program.

Operations Access Specialist

The Operations Access Specialist performs administrative services for an assigned program/location. This role ensures efficiencies, organization, and successful outcomes applicable to role and environment.

Job Responsibilities

• The Ops Access Specialist title is used in multiple departments within Shepherd Center and performs various duties in order to ensure proper functioning as applicable to role and assigned unit.
• Patient Financial Services Summary: Responsible for accurate and timely follow-up and collections of Patient Accounts as assigned. Follows through on assigned accounts until paid in full.
• Mild TBI/Concussion Clinic, Outpatient Registration, Pathways Summary: Performs administrative services for assigned unit to include maintaining efficient office organization; screening and handling incoming telephone calls; managing routine assignments; assisting with special events and projects; and managing patients visits.
• Calls carrier and completes follow-up on all assigned claims not paid within 30 days of initial claim submission.
• Print rebills as necessary to mail or fax in effort to expedite payment.
• Works closely with the PFS supervisor to assure feedback is routed to registration and billing areas as identified.
• Notes all activity in patient notes thoroughly.
• Reviews all EOBs on insurance payments received to assure accurate payment received, accurate charges processed, and contractual allowances posted accurately as time allows.
• Identifies bad debt and charity accounts and forwards to PFS Supervisor for approval.
• Assures all documentation and additional information requested by attorneys, physician offices, insurance carriers, patients, and other external sources, is provided in a timely manner.
• Responds to correspondence and phone messages in a timely manner.
• Keeps abreast of current billing requirements.
• Is proactive in developing solutions or improvements related to the position.
• Notifies management of any unresolved issues, problems related to the position. Resolves accounts per policy and procedure.
• Completes special projects and requests as assigned by management.
• Prints EOB's and Medical Records via ImpactMD as needed
• TBI/CC: -Effectively handles incoming/outgoing phone calls on multiple lines. Information needs of telephone callers are met when possible. If caller cannot be helped, caller is directed to correct source.
• Greets clients, families, and visitors in a friendly and considerate manner. Assists customers in receiving services from appropriate staff member. Assists clients in signing in/out
• Maintains appropriate office supplies. Supply room is kept clean and organized.
• Types all delegated material (graduation certificates, general correspondence, reports, memos, team reports, special assignments, etc.) within a reasonable time frame or by specified deadline.
• Responds promptly to changes in schedule and notifies appropriate parties of changes and assists staff as requested.
• Maintains cleanliness of reception and common areas. Notifies appropriate staff for any needed clean up or repairs in these areas.
• Distributes department mail promptly and accurately. Ensure outgoing mail is sent out daily
• Reviews messages from overnight answering service daily and notifies appropriate staff of client illness/tardiness/out of center.
• Places phone on night service at end of day.
• Ensures all doors to client building and garage are locked each day prior to end of shift.
• Performs special assignments and projects as instructed by supervisor in a timely and thorough manner.
• Organizes work/time effectively and prepares for coverage of Accountabilities during scheduled time off.
• Keeps track of client cancellations, compiles, and types Actual Versus Scheduled Report at the end of every month.
• Completes registration process of all new admissions.
• Maintains confidentiality in all interactions.
• Outpatient: -Schedule outpatient appointments with the appropriate service, professional or disciplines according to established guidelines.
• Schedule appointments for new evaluation, post discharges, follow-up visits, diagnostics, therapy, and counseling appointments.
• Confirm demographic and insurance data when patient is scheduled/registered.
• Return all phone calls regarding scheduling within 24 hours.
• Communicate with physicians and management regarding the changes in schedules, addressing problem/issues effectively.
• Proactive in the overall effective management of the schedules. (e.g. maintain patient wait-list, send confirmation letters, etc.)
• Monitor all computer software maintenance functions related to patient access.
• Collect complete referral intake information on New Patients.
• Complete all steps to schedule and prepare daily appointment packet accurately.
• Confirm, update and/or make copies of insurance cards and patient identification at each visit.
• Obtain "consent to treat" with the signature of responsible party, and ensure it is completed accurately.
• Notify clinical staff immediately, after patient completes registration process
• Follow check-in and check-out process according to policy.
• Complete MSPQ as required during registration.
• Notify Financial Counselors of any benefits that require pre-certification or referral authorization.
• Obtain complete referral information if required.
• Review and respond promptly to all intra and interdepartmental communications, (i.e., staff meetings minutes, attachments, e-mails, P&P, etc.)
• Proactively notify supervisor as appropriate regarding patient complaints, when registration is backed up, when tasks/expectations are not able to be met.
• Perform other duties as assigned by management.
• Accountabilities Pathways: -Maintain efficient office organization, taking inventory and ordering new supplies as needed.
• Greet clients, families and visitors in a friendly and considerate manner; assists customers in receiving services from appropriate staff member.
• Screen and handle incoming telephone calls.
• Assist with special events and projects.
• Complete registration process of all new admissions: obtain consent forms, obtain copy of client insurance card, and take a picture of client.
• Keep track of client cancellations, compiles and types Actual Versus Scheduled Report at the end of every month.
• Type all delegated material (graduation certificates, general correspondence, reports, memos, team reports, special assignments, etc.).
• Distribute department mail and ensure that outgoing mail is sent out daily.

Required Minimum Education

• High School Diploma or equivalent

Required Minimum Certification

• N/A

Required Licensure

• N/A

Required Minimum Experience

• Minimum of two years' professional experience in an outpatient setting, rehabilitation center, or as an external case manager.
• Knowledge of Commercial, Managed Care Contracts and Governmental Insurance Plans.
• Experience in automated systems, overall knowledge of business office procedures and hospital policy, knowledge of third-party payors.
• Excellent communication and customer service skills.
• Familiar with general office equipment.

Required Minimum Skills

• Must have a working knowledge of PC spreadsheet and database software.
• Strong math aptitude required.
• Personal computer experience required.
• Expertise in the following software preferred: Outlook, Word, Excel, Epic and medical terminology.

Preferred Qualifications

• Certified Healthcare Access Associate (CHAA) certification preferred.
• Certified Patient Account Representative (CPAR) certification preferred.

Physical Demands

• Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time or exerting up to 15 pounds of force occasionally or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body.

Working Conditions

• Some potential for exposure to blood and body fluids.