- High school diploma or equivalent.
- Two (2) years of related experience in insurance, managed care referral processes, private physician's office practice or hospital registration setting.
- Bachelor's degree.
- Three (3) years of related experience in insurance, managed care referral processes, private physician's office practice or hospital registration setting.
- MassHealth Certified Application Counselor.
- Coordinates all incoming referrals for consultations from physician practices, hospitals, nursing homes and other healthcare facilities.
- Compiles all clinical data, including physician notes, patient history, laboratory and imaging results and other clinical information necessary from referring physician or facility.
- Arranges and schedules consultation appointments with patients, confirming demographic information and verifying insurance payor eligibility.
- Verifies insurance, checks benefits, obtains patient responsibility from payer, etc.
- Meets with the patient and family during the interdisciplinary introduction meetings to review the patient's insurance(s), insurance coverage, out-of-pocket costs, etc.
- Serves as patient liaison for financial matters throughout treatment, including following up on insurance and financial risk assessment every quarter.
- Collects patient responsibility pre-service. Establishes payment plan, if necessary.
- Completes, files, and follows to resolution applications for Massachusetts Medicaid, including disability, Health Safety Net, and other such programs.
- Refers patients to programs where Hospital staff cannot file directly for the patient, including Veteran's Services, and EAEDC.
- Works closely with and communicates consistently with Social Work, Case Management, Billing, and Contracting to provide a cohesive support system to the patient and the clinical providers.
- Stays abreast of regulations, making certain that applications are appropriate and complete to ensure that the Hospital, the professional groups, and the patient receive all benefits for which the patient is eligible.
- Documents all meeting minutes and steps taken on an account.
- Processes all medical record requests from patients, insurance companies, attorneys, etc. Informs request of fee, if applicable, and ensure payment received prior to record released.
- Requests and obtains insurance referral from referring physician or patient's primary care physician.
- Sends all pre-visit paperwork to patient with clear instructions.
- Assists patient with maximizing insurance benefits.
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patient access specialist - Lawrence, MA , USA, United States - Tufts Medicine
Description
We're saving lives, building careers, and reimagining healthcare. We can't wait to grow alongside you.Job Profile
Summary
This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing.
In addition, this role focuses on performing the following Patient Access duties:
Performs the administrative and financial-clearance duties necessary to facilitate the procurement of clinical services by patients.
Collects patient's necessary demographic and financial information from physician offices, acute-care entities, or the patients themselves, schedules services for patients, and handles referrals from primary care doctors to ensure patients are scheduled for recommended appointments/procedures, etc.
An organizational related support or service (administrative or clerical) role or a role that focuses on support of daily business activities (e.g., technical, clinical, non-clinical) operating in a hands on environment.
The majority of time is spent in the delivery of support services or activities, typically under supervision.An entry level role that typically requires little to no prior knowledge or experience, work is routine or follows standard procedures, work is closely supervised, and communicates information that requires little explanation or interpretation.
Job Overview
This position coordinates all tasks associated with incoming consultation referrals from physician practices, hospitals and other healthcare facilities, as well as all benefit and referral management and medical record request management.
Job Description
Minimum Qualifications:
Preferred Qualifications:
Duties and Responsibilities
: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list. Other duties and responsibilities may be assigned.
Tufts Medicine is a leading integrated health system bringing together the best of academic and community healthcare to deliver exceptional, connected and accessible care experiences to consumers across Massachusetts.
Comprised of Tufts Medical Center, Lowell General Hospital, MelroseWakefield Hospital, Lawrence Memorial Hospital of Medford, Care at Home - an expansive home care network, and large integrated physician network.
We are an equal opportunity employer and value diversity and inclusion at Tufts Medicine.Tufts Medicine does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law.
We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
Please contact us to request accommodation by emailing us at .
