PATIENT ACCESS ASSOCIATE III

The Pre-Access Authorization Associate for Benefits and Authorizations at Riverside Healthcare is responsible for managing complex registration processes, insurance verification, and authorization requests. This role requires proficiency in analyzing and complying with insurance, Medicare, and Medicaid regulations, while maintaining exceptional customer service. The Associate will ensure that patients and their representatives understand the hospital's revenue expectations and navigate payment options effectively. This position demands the ability to work independently in a fast-paced environment, providing compassionate and customer-focused service.

Essential Duties

• Registration and Data Collection:
• Accurately collect, analyze, and record demographic, insurance/financial, and clinical data from multiple sources for patient registration and billing.
• Obtain necessary information and signatures for registration and payor authorizations, ensuring completeness and accuracy.
• Insurance and Authorization Management:
• Review and analyze physician orders and documentation against payer coverage and medical necessity criteria.
• Utilize screening software to determine if services meet third-party requirements for payment.
• Initiate and manage the authorization process for Riverside Medical Group, communicating clinical information to insurance companies as needed.
• Contact physicians for additional clinical information and inform them about payer requirements.
• Explain payer policies and financial responsibilities to patients, ensuring they understand their obligations within the revenue cycle.
• Compliance and Documentation:
• Follow HIPAA and other regulatory standards for registration, billing, and authorization processes.
• Document financial expectations and medical necessity verifications accurately and thoroughly.
• Maintain assigned work queues and review call software consistently to manage workload and meet departmental goals.
• Customer Service:
• Interact with patients, their representatives, and internal/external entities in a courteous and professional manner.
• Provide clear explanations of the authorization and billing processes, ensuring patient understanding and satisfaction.
• Refer patients and their representatives to Patient Financial Services as needed.
• Administrative and Reporting Duties:
• Attend mandatory continuing education and department meetings to stay updated on policies and procedures.
• Review and respond to email communications promptly to keep abreast of current information.
• Perform timely and accurate documentation and reporting of authorization activities

Non-essential Duties

• Support additional administrative tasks and projects as assigned by the supervisor.
• Participate in departmental initiatives and improvements to enhance patient access services.

Preferred Experience

• Prior experience in obtaining authorizations and understanding payer regulatory compliance preferred.
• Office or clerical experience preferred.
• Prior knowledge of HIPAA Privacy and Security requirements and the hospital revenue cycle.
• Medical Terminology preferred
• Strong customer service skills with the ability to communicate effectively and compassionately.
• Detail-oriented, with a commitment to accuracy and problem-solving abilities.
• Proficient in general arithmetic and computer literacy, with the ability to learn new software applications.
• Ability to work independently and manage multiple tasks in a fast-paced environment.

Required Licensure/Education

• High school diploma or equivalent required.

Employee Health Requirements

Exposure/Sensory Requirements

Exposure to: 

• Chemicals: None 
• Video Display Terminals: Average 
• Blood and Body Fluids: Performing ER and Admitting registrations have the potential to be exposed. 
• TB or Airborne Pathogens: Performing ER and Admitting registrations have the potential to be exposed. 

Sensory requirements (speech, vision, smell, hearing, touch):

• Speech: Required to communicate during presentations/training, telephone communication, and facilitate meetings. 
• Vision: Needed to read memos and literature, close vision (ability to adjust focus). 
• Smell: NA 
• Hearing: Needed for telephone communication, meetings, alarms and listening to employee concerns. 
• Touch: Needed to write, computer entry, filing. 

Activity/Lifting Requirements 

Percentage of time during the normal workday the employee is required to:

• Sit: 50-88% 
• Twist: 5% 
• Stand: 1% 
• Crawl: 0% 
• Walk: 12-50% 
• Kneel: 0% 
• Lift: 0% 
• Drive: 0% 
• Squat: 0% 
• Climb: 0% 
• Bend: 5% 
• Reach above shoulders: 2% 

The weight required to be lifted each normal workday according to the continuum described below:

• Up to 10 lbs: Frequently 
• Up to 20 lbs: Frequently 
• Up to 35 lbs: Occasionally 
• Up to 50 lbs: Occasionally 
• Up to 75 lbs: Not Required 
• Up to 100 lbs: Not Required 
• Over 100 lbs: Not Required 

Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.): 

• Carrying materials such as charts and labels waist high and for approximately 20 feet. 

Maximum consecutive time (minutes) during the normal workday for each activity:

• Sit: 30 
• Twist: 1 
• Stand: 5 
• Crawl: 0 
• Walk: 5 
• Kneel: 0 
• Lift: 0 
• Drive: 0 
• Squat: 0 
• Climb: 0 
• Bend: 0 
• Reach above shoulders: 1 

Repetitive use of hands (Frequency indicated): 

• Simple grasp up to 10 lbs. 
• Normal weight: 5- 10# frequent 
• Pushing &pulling Normal weight: 
• Fine Manipulation: Computer keyboard, writing, calculator. 

Repetitive use of foot or feet in operating machine control: Not Required 

Environmental Factors &Special Hazards

• Environmental Factors (Time Spent): 
• Inside hours: 8 
• Outside hours : 0 
• Temperature: Normal Range 
• Lighting: Average  
• Noise levels: Average 
• Humidity: Normal Range 
• Atmosphere: 
• Special Hazards: 
• Protective Clothing Required: None