Patient Access Procedure Coordinator (M-F)

Job Description

Job Description

Description:

CLEVELAND AREA HOSPITAL is an independent, self-managed Critical Access Hospital half an hour west of Tulsa, Oklahoma. As the only hospital in Pawnee County, we are constantly striving to provide the highest level of care by continuously growing and updating our services and equipment. Continuing the spirit of growth, healing, and service-driven healthcare established when the hospital first opened in 1963, Cleveland Area Hospital is on track to build a new facility, expand our services, and better serve our patients and communities.

· Are you passionate about patient care?

· Would you enjoy being an integral part of a team on the verge of new hospital construction?

· Are you motivated by ongoing improvement and an opportunity to make a measurable impact on rural healthcare in Oklahoma?

POSITION SUMMARY: The Patient Access Procedure Coordinator plays a critical role in the operational success of Cleveland Area Hospital by ensuring that all services provided to patients are authorized by their insurance carriers. This position is responsible for verifying insurance coverage, assessing the medical necessity of services, and facilitating the authorization process to optimize reimbursement and reduce claim denials.

Reasonable accommodation may be made to enable individuals with disabilities to perform the essential function

PRINCIPAL JOB DUTIES AND RESPONSIBILITIES:

1. Adhere to all policies of the organization.

2. Conduct thorough verification of patients' insurance coverage prior to scheduled services.

3. Confirm eligibility and benefits with insurance providers to ensure services are covered under the patient’s plan.

4. Verify orders from referring providers are complete and information is accurate.

5. Review diagnosis codes to determine the medical necessity of requested services.

6. Collaborate with healthcare providers to obtain additional clinical information as needed to support authorization requests.

7. Obtain and/or confirm authorizations for services from insurance companies.

8. Monitor the status of authorization requests and follow up with insurers to expedite processing.

9. Maintain accurate records of authorization requests, approvals, and denials.

10. Communicate effectively with the billing and coding departments to resolve any discrepancies related to authorizations.

11. Inform patients of their insurance benefits and any necessary out-of-pocket costs related to their services.

12. Address patient inquiries regarding authorization status and insurance coverage in a professional and empathetic manner.

13. Stay updated on insurance policies, regulations, and changes that may affect authorization processes.

14. Other duties as assigned.

EQUIPMENT:

Computer and Printer

Copy Machine

Fax Machine

Telephone

BENEFITS:

• Competitive pay
• Comprehensive benefits package including medical, dental, vision, FSA, and Life/AD&D
• 401k with up to 4% matching after first year
• Excellent PTO accrual from the date of hire
• Generous Tuition Reimbursement Program
• Employee Appreciation and Engagement
  • Birthday, Anniversary and New Hire Gifts
  • Uniform Vouchers (annually and upon hire)
  • Employee Engagement events
  • Employee Referral incentives

EDUCATION/SKILLS REQUIRED:

• High School diploma or equivalent. Must possess excellent communication and organizational skills. Working knowledge of computer-based applications and strong PC/keyboard skills are a must.
• Strong knowledge of insurance policies, medical necessity criteria, and healthcare regulations.
• Excellent communication and interpersonal skills, with the ability to interact effectively with patients and insurance representatives.
• Proficient in using medical billing software and electronic health record (EHR) systems.
• Exceptional organizational skills and attention to detail, with the ability to manage multiple tasks and meet deadlines.

EXPERIENCE:

1-2 years of experience in the medical field, hospital, or physician office. Insurance verification, or authorization role preferred.

RESPONSIBILITY FOR CONFIDENTIAL INFORMATION:

This position could have access to patient confidential records and must comply with HIPAA regulations as well as Compliance Policies.

WORKING CONDITIONS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to sit for extended periods of time; stand; walk; use hands to finger, handle or feel; and reach with hands and arms. Must be able to push, pull 250 lbs. and lift 50 lbs. using appropriate body mechanics techniques. Utilizes good hearing, vocal and visual skills. Occasionally it requires bending and stretching. Pushing and pulling. May be exposed to communicable diseases.

The above statements reflect the general details considered necessary to describe the principal function of the job as identified and shall not be considered as a detailed description of all work requirements that may be inherent to this position.