The Access Specialist- Therapy Services, communicates with patients/providers via telephone to ensure accurate, prompt and courteous scheduling of therapy appointments according to established guidelines. This position is responsible for obtaining and entering accurate demographic and insurance information for all encounters. The Therapy Access Specialist is required to discuss financial obligations with patient families and collect when appropriate. The Therapy Access Specialist is responsible for monitoring registration and insurance related items that fall into patient work queues to ensure timely claim filing. This role works collaboratively with program managers and supervisors to ensure all patients' access needs are met. The Therapy Access Specialist is required to provide superior customer service to both internal and external customers, and represent Nemours in a positive, professional manner. They are responsible for demonstrating a commitment to service, organization values, and professionalism through appropriate conduct and demeanor at all times.
Primary Responsibilities:
Promptly answers incoming calls to schedule appointment for patients; makes outbound calls when follow-up is needed.
Provide a smooth transition for all internal and external customers by utilizing excellent customer service skills and effective communication.
Ensures efficient processing and documentation of all information required for insurance verification, registration and billing in the Electronic Medical Record (EMR) system.
Schedule patient appointment according to established division guidelines and communicate updates and barriers in a timely manner.
Ensure urgent diagnosis and appointments are handled with priority and escalation processes are utilized when necessary.
Verify insurance eligibility and authorizations utilizing the available resource tools.
Utilize the Managed Care Manual to verify participating insurances and their requirements.
Inform the caller of their financial responsibility that is due at the time of service/offer to collect in advance at the time of scheduling and ensure accurate daily cash reconciliation.
Adhere to the authorization process by informing the caller that an authorization is needed (if applicable) at the time the appointment is made.
Refer patients to the Financial Advocates if financial assistance is needed.
Educate the callers on the preparation for the appointment or requirements needed to ensure a productive visit.
Accurately notate the patient's accounts to communicate pertinent information to clinic, registration, authorization, family financial, and billing departments.
Request medical records when necessary.
Review work queues on a daily basis, make corrections and/or escalate to leadership if necessary.
Respond to and complete staff message.
Review and take the necessary action to ensure patient scheduled appointments are accurate.
Always offer specific directions to the clinic and location that they will be seen.
Stay up-to-date of appointment scheduling changes and insurance requirements.
Interact with coworkers and clinic personnel in a professional manner.
Communicates effectively with patients, physicians and/or other departments regarding delays or any issues relating to patient appointments.
Consistently achieve team metric standards and expectations.
Maintains strict confidentiality at all times.
Positively support mission, vision and values of Nemours.
Brings forth any compliance/ethic issues and recommendations for operational improvement.
Ensures successful adherence to policies, procedures and changes to the organization.