Access Coordinator, Patient Access, First Shift

Access Coordinator, First Shift, Patient Access
UC Health is hiring a full-time Access Coordinator for the Patient Access department. This is a first shift position with UC Health, LLC.
The Access Coordinator will support Patient Accessdelivering high-quality care to patients based on assessed needs, established standards of care and according to policy and procedures.
About UC Health, LLC
UC Health is an integrated academic health system serving Greater Cincinnati and Northern Kentucky. In partnership with the University of Cincinnati, UC Health combines clinical expertise and compassion with research and teaching-a combination that provides patients with options for even the most complex situations. Members of UC Health include: UC Medical Center, West Chester Hospital, Daniel Drake Center for Post-Acute Care, Bridgeway Pointe Assisted Living, University of Cincinnati Physicians and UC Health Ambulatory Services (with more than 900 board-certified clinicians and surgeons), Lindner Center of HOPE and several specialized institutes including: UC Gardner Neuroscience Institute and the University of Cincinnati Cancer Center. Many UC Health locations have received national recognition for outstanding quality and patient satisfaction. Learn more at uchealth.com.
Unit Details :

• A structured 4-tier career ladder for continued career advancement.
• A remote opportunity by working from home.
• A work environment where your contributions and ideas are valued.

Responsibilities
Job Responsibilities
An Access Coordinator is responsible for independently managing all work related to medical necessity-based authorizations for all Scheduled Surgeries, Outpatient, and Inpatient, as well as Elective and Direct medical admissions. Able to determine a patient's eligibility and identify specific insurance benefits for all Scheduled Surgeries, Outpatient, and Inpatient, as well as Elective, Emergent, and Direct medical admissions. Possess a strong knowledge of Insurance payors while demonstrating a solid understanding of payer coverage policies and applying appropriate payer criteria and guidelines.
The coordinator will leverage their understanding of medical terminology and physiology to retrieve the appropriate clinical documents (e.g., progress notes, lab values, scan results) from the electronic medical record (EMR). The Access Coordinator will complete specific forms and enter required information via payor portals to secure prior authorization, reduce penalties, and achieve maximum reimbursement.

• Reviews and monitors all insurance verification work queues, identify, and prioritizes accounts with the greatest financial reimbursement risk.

• Reprioritizes work to respond to urgent clinical needs and produces high quality work under pressure.

• Verifies insurance eligibility and benefits, utilizing automated eligibility systems, payer portals, or telephone communication.

• Prepares and completes payer-specific prior authorization requests, interprets medical policy criteria, and applies appropriate guidelines to prior authorization requests.

• Identifies appropriate medical documentation to satisfy payer medical policy criteria.

• Respond to health plan-reviewed prior authorization requests that do not meet initial policy criteria. Works with the health plan to resolve issues and/or coordinates appropriate provider-to-health plan interventions (e.g., peer-to-peer discussions, letters of medical necessity, provider-initiated appeals, etc.).

• Provides superior customer service to all patients, works through patient-raised issues, and recommends appropriate solutions.

• Interfaces with provider's offices and medical staff to ensure all necessary documentation is obtained for purposes of pursuing a successful authorization approval.

• Documents accurately into the Electronic Medical Record (EMR) system all actions, interactions, and authorizations surrounding the insurance process for each patient.

• This position has no supervisory responsibilities.

• Duties, responsibilities, and activities may change at any time with or without notice.

• Other duties may be assigned as needed by supervision.

Qualifications
Education and Experience Requirements:

• Detail oriented and able to follow complex instructions.
• Excellent communication and problem-solving skills.
• A strong medical terminology / background.
• 3 - 5 Years equivalent experience completing Registration, Scheduling, Pre-certifications/prior authorizations in a hospital setting, medical office setting, Patient Access, or similar environment preferred.
• 1 - 2 Years equivalent experience completing Registration, Scheduling, Pre-certifications/prior authorizations in a hospital setting, medical office setting, Patient Access, or similar environment.
• High School Diploma or GED required.

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