PAS Payer Notification III at Wellstar Health Systems in Marietta, Georgia

Job Description:

Facility: Kennestone Hospital



Job Summary: The Patient Access Services (PAS) Payer Notification Specialist III position reports to the PAS Supervisor, Manager or Director and is responsible to secure accounts for admitted patients by performing the timely notification of admission to the respective payer(s) listed on the patient account. The Specialist may complete a combination of insurance verification to gather benefit information if not already obtained and initiates the necessary payer admission notification. This position works closely with Utilization Management, Care Coordination, and other business partners to resolve issues that arise during the patient's hospitalization to ensure notifications are submitted timely and accurately. As with all Revenue Cycle PAS positions, Specialists are expected to maintain established productivity benchmarks and meet goals in a fast-paced environment. Other duties as assigned.
Core Responsibilities and Essential Functions: Quality/ Safety * Works in conjunction with the PAS Supervisors, Financial Counselors, Utilization Management and Care Coordination teams to ensure prompt notification of admission to payers. * Ensures accurate insurance is reflected on the patient account by confirming the presence of the eligibility response for the correct date and assessing the guarantor record for other possible payers. * Secures confirmation the notification was received timely and documents status within the patient account. * Follows up on delayed or pending notifications and escalates for resolution. * Creates detailed documentation and maintains/stores the notification paper/electronic trail. * May work in the work queues to resolve claims denials related to late or missing notifications. * Perform other work-related duties as requested/directed by management. * Observes work hours and provides proper notice of absences, tardiness, or work schedule changes. * Maintains courteous and cooperative working relationships with WHS management, patients, physicians, other professional contacts, and the public. Demonstrates ability to tactfully handle difficult situations. * Documents thorough explanatory notes on patient accounts, concerning any non-routine circumstances, clarifying special billing processes. * Maintains a working knowledge of available information system capabilities and performs all system applications that are required. * Understands and applies WHS philosophy and objectives, and PAS policies and procedures, as related to assigned duties. Understands the admission, outpatient and emergency registration process. * Maintains confidentiality of patient information, in accordance with WHS policy and HIPPA regulations. * Maintains knowledge of standard and administrative, and department policies, procedures, and protocols. * Consistently demonstrates the ability to organize work, recognizes and establishes appropriate work priorities, and completes work in a productive manner, without creating backlogs. * Maintains proficiency in data entry skills. * Assists physicians and their office staff to expedite scheduling, pre-admission, Medicaid screening and pre-certifications on all accounts. * Resolves errors and applicable Claim, DNB and Patient Work Queues. * Performs other duties as assigned. Budget/Financial * Initiates timely notification of admission to payers. * Monitors in-house accounts to identify changes which may result in new notification requirements. * Maintains a current list of health plans and the payer notification requirements. * Works efficiently and accurately within designated time frames to ensure a continuity of information and cash flow. * Coordinates activities with Admitting, Outpatient Registration, Emergency Registration, Utilization Review, Nursing, and other business partners. * Verifies insurance coverage and benefits as required to ensure payer accuracy. * Exceeds monthly quota on a consistent basis. Formally reports results of notifications to direct supervisor, on a daily basis or according to policy. Provides feedback to PAS management concerning data integrity issues. * Responsible for completion of appropriate error/issues in Work Queues. * Identifies and resolves Payor Denials as indicated. Customer Service * Greets all guest with a positive and professional attitude. * Receives patients valuables for safekeeping in the hospital safe. * Answers incoming phone calls and follows through with requests made. * Maintains courteous and cooperative working relationships with WHS management, patients, physicians, other professional contacts, and the general public. Demonstrates ability to tactfully handle difficult situations. * Presents a well-groomed and professional image in coordination with dept/hospital dress codes. Expected Performance, Behaviors and Results: * The WellStar Experience (Must demonstrate a commitment to Service Excellence by): * Creating first impressions, memorable moments and impressions that fulfill the expressed and unexpressed wishes and needs of patients and family members. * Valuing patients and family members as partners in their care. * Having world-class processes in place. * Delivering high-touch care that is reliable, responsive and coordinated. * Focusing on constant innovation and creating improvements. * Celebrating our diversity with sensitivity and understanding. * Embracing the idea that we are all owners of our health system. General * Observes work hours and provides proper notice of absences, tardies work schedule changes. * Attends select departmental meetings at the request of WHS Management. * Completes monthly, quarterly, and annual mandatory training as required. * Performs other duties as assigned. PAS III Team members serve as preceptors and mentors and as such must: * Maintain a based on individual QA audit /or as reported by Epic (min. of 10 accounts) registration accuracy rate or higher in the past 12 months. * Maintain minimum productivity requirements. * Has no corrective disciplinary action during the past twelve (12) months. * Willing and able to function as a preceptor in the orientation of new patient access personnel and students. * Maintain required certifications by obtaining necessary CEUs and submitting timely to certifying board. Performs other duties as assigned Complies with all WellStar Health System policies, standards of work, and code of conduct.
Required Minimum Education: High school diploma Required or GED Required and Associate's Degree Preferred
Required Minimum License(s) and Certification(s): All certifications are required upon hire unless otherwise stated.

• Cert Healthcare Access Assoc or Certified Patient Account Rep or Certified Revenue Cycle Rep

Additional License(s) and Certification(s):

Required Minimum Experience: Minimum 1 year of healthcare experience in Patient Access Services, Practice Operations, or Patient Financial Services. Required and Bachelors degree or higher may substitute for experience. Required and Epic experience Preferred
Required Minimum Skills: Effective communication skills (both written and verbal) with the ability to communicate with various members of the healthcare team. High attention to detail, self-directed and a positive attitude are essential. Effective problem solving and critical thinking skills. Typing or data entry competency of at least 40 words/minute. Cash handling and balancing. Demonstrated professionalism, effective communication skills and active listening skills. Working knowledge of patient registration systems and intermediate Microsoft Office Suite are preferred. Apply Now