Access Center Specialist II - Orthopedics - Nemours

The Access Specialist II - Outbound Focus Orthopedics serves as a liaison between the provider and the patient to ensure patients' access needs are met timely. This is a versatile position that supports provider activity at Nemours Children's Hospital, Delaware and our partner hospitals/locations by processing scheduling requests from patient families or Nemours providers via fax, email, or web portal, daily completion of reports and work queues to ensure quality standards are met, obtaining imaging for upcoming Orthopedic appointments via phone/fax, and receiving incoming calls from patients/providers via telephone. The Specialist performs registration and insurance verification activities in accordance with established hospital and departmental policies and procedures, and ensures timely creation of a patient encounter. This position works with partner hospitals, off-site office locations, community and Nemours primary care providers, and families to obtain the necessary information required for accurate registration and insurance verification. In addition, the Specialist communicates with patients/providers via telephone to ensure accurate, prompt and courteous scheduling of specialty appointments according to established division guidelines. This position is responsible for obtaining and entering accurate demographic insurance information for all encounters. The Access Specialist II is required to discuss financial obligations with patient families and collect when appropriate. The Access Specialist II is responsible for monitoring registration and insurance related items that fall into patient work queues to ensure timely claim filing. This role work collaboratively with administrative assistants and department managers to ensure all patients' access needs are met. The Access Specialist II 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.

Essential Functions:

1. Make outbound calls to families to schedule patient/provider requested appointments and follow up needed.

2. Promptly answers incoming calls from patients/providers to schedule appointments for patients as needed.

3. Process patient/provider consult requests received via email, EPIC in basket messages, or through the Nemours app.

4. Provide a smooth transition for all internal and external customers by utilizing excellent customer service skills and effective communication.

5. Ensures efficient processing and documentation of all information required for insurance verification, registration and billing in the Electronic Medical Record (EMR) system.

6. Schedule patient appointment according to established division guidelines and communicate updates and barriers in a timely manner.

7. Ensure urgent diagnosis and appointments are handled with priority and escalation processes are utilized when necessary.

8. Verify insurance eligibility and authorizations utilizing the available resource tools.

9. Utilize the Managed Care Manual to verify participating insurances and their requirements.

10. When applicable, 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.

11. Adhere to the authorization process by informing the caller that an authorization is needed (if applicable) at the time the appointment is made.

12. Refer patients to the Financial Advocates if financial assistance is needed.

13. Educate the callers on the preparation for the appointment or requirements needed to ensure a productive visit.

14. Accurately notate the patient's accounts to communicate pertinent information to clinic, registration, authorization, family financial, and billing departments.

15. Request medical records when necessary.

16. Review work queues and reports on a daily basis, make corrections and/or escalate to leadership if necessary.

17. Respond to and complete staff message.

18. Provide support for Cancelled Clinic requests.

19. Review and take the necessary action to ensure patient scheduled appointments are accurate.

20. Always offer specific directions to the clinic and location that they will be seen.

21. Stay up-to-date of appointment scheduling changes and insurance requirements.

22. Interact with coworkers and clinic personnel in a professional manner.

23. Communicates effectively with patients, physicians and/or other departments regarding delays or any issues relating to patient appointments.

24. Consistently achieve team metric standards and expectations.

25. Maintains strict confidentiality at all times.

26. Positively support mission, vision and values of Nemours.

27. Brings forth any compliance/ethic issues and recommendations for operational improvement.

28. Ensures successful adherence to policies, procedures and changes to the organization.

29. Additional miscellaneous duties and responsibilities, as may be assigned from time to time by employee's supervisor.

30. Demonstrate reliability in daily work practices with a clear understanding of Nemours policies and procedures.

Requirements:

HS Diploma or equivalent and one year of specialized training after high school

NAHAM certification - CHAA preferred

Three to five years of experience in Health Care, Call Center, Customer Service

Experience with Windows based systems and strong keyboarding skills