|Job type||Full Time|
About Children's Minnesota
Children's Minnesota is the seventh largest pediatric health system in the United States and the only health system in Minnesota to provide care exclusively to children, from before birth through young adulthood. An independent and not-for-profit system since 1924, Children's serves kids throughout the Upper Midwest at two free-standing hospitals, 12 primary and specialty care clinics and six rehabilitation sites. Additionally, Children's is Minnesota's only Level I pediatric trauma center inside a hospital dedicated solely to children. In 2018 Children's Minnesota was verified as a Level I Children's Surgery Center by the American College of Surgeons. Children's maintains its longstanding commitment to the community to improve children's health by providing high-quality, family-centered pediatric services and advancing those efforts through research and education. This work is made possible in large part by generous philanthropic and volunteer support from individuals and organizations throughout the state and region. An award-winning health system, Children's received Magnet® recognition from The American Nurses Credentialing Center (ANCC) in 2018 and is regularly ranked by U.S. News & World Report as a top children's hospital. Please visit childrensMN.org .
Comprehensive interdisciplinary initial evaluation, follow-up and management of congenital and acquired endocrine disorders, including: diabetes, growth problems, thyroid disorders, etc. This department also provide an education program for children and their families that includes diabetes management and nutrition counseling as well as resources, support groups, for children and their families.
The Patient Access Specialist will serve as a resource for patients and provide excellent customer service in a professional manner. This position requires critical thinking skills, a strong work ethic and is essential for Children's to achieve identified financial benefits. Supports management and team members and performs all duties in a manner which promotes team concept and reflects the mission and vision of Children's Hospitals and Clinics of Minnesota. The Patient Access Specialist also is responsible for communication with clinics and various ancillary services related to insurance coverage issues. Ensures compliance with local, state, federal, third party, EMTALA, and JCAHO regulations. Strives to minimize patient arrival to treatment area time, improving customer satisfaction as it relates to the registration process, waiting time and general communications.
Responsibilities include: preregistration/registration, insurance verification and eligibility checks, and referrals to financial counseling for financial assistance options. May also include obtaining initial authorization, and notifying payers of patient arrival. The Patient Access Specialist will serve as a resource for patients and provide excellent customer service in a professional manner.
* High school diploma or equivalent experience required.
* Post secondary education preferred.
* Medical Terminology certificate is preferred.
* 1-2 years previous registration experience preferred. Comparable experience in healthcare revenue cycle operations is acceptable (e.g.; scheduling, billing, call center, registration, financial counseling).
* Working knowledge of eligibility verification and prior authorizations for payment from various HMOs,PPOs, commercial payers and other funding sources preferred.
* Working knowledge of medical terminology preferred.
* Working knowledge of the revenue cycle preferred.
* Previous experience with cash collection preferred.
* Working knowledge of diagnostic, procedure, supplies and/or facility coding specific to area of authorization required by department/unit preferred.
* Previous experience working in a team environment.
Skills And Abilities Required:
* Communication - Excellent customer service skills, strong communication skills, excellent phone etiquette, ability to handle patient complaints to resolution following the 4 A's as outlined by Children's Service Standards.
* Computer - Window-based PC skills, keyboarding, 40 wpm (speed and accuracy), utilizing payer web pages, data entry ability.
* Organizational - Ability to organize/prioritize work and manage time effectively, ability to work from multiple
schedules, detail oriented; ability to multitask, excellent follow-through skills.
* Technical - Knowledge of hospital, regulatory and compliance policies and procedures preferred,
knowledge and understanding of insurance payer requirements.
* Problem solving - Critical thinking skills, resourcefulness, self-motivated, detail oriented, continuous quality improvement/process improvement orientation.
* Understands and upholds the basic philosophies of the revenue cycle, accounts receivable, and patient accounts.
Senior Patient Access Specialist - Centralized Authorization Team
The PAS Centralized Authorization Team is located in the Centre Pointe building. The focus of this team is on high dollar facility accounts (inpatient and outpatient). Responsibilities include preregistration, insurance verification and eligibility checks, determination of health plan authorization requirements, collaborating with employed and referring physician groups to obtain information needed to request authorizations, pre-service calculation of patients' financial obligation, communication of financial liability amount to families prior to scheduled service, referrals to financial counseling for financial assistance options, and submitting inpatient admission notifications.
* Using the criteria provided, and coverage information obtained (from the eligibility verification); identify patients who are underinsured and refer the account to financial counseling.
* Working knowledge of PowerChart.
* Assist the billing office (when needed) in working with the health plan to reverse authorization or notification related denials.
* Requires the use of multiple systems/applications for obtaining information: Cerner, Aeos, invision, healthia, scheduling, health plan web-sites, McAnalytics, etc.
* Performs payor notification and obtains certification for inpatient hospital admissions, within the payor specified time-frame.
* Communicates with Case Management Assistants as needed, regarding the authorization status for inpatient accounts.
* Responsible for updating inpatient accounts in the billing system with active insurance information, (if it was not in place at the time of admission), and obtain retro-authorization if needed.
* Calculate expected patient/family financial liability amounts for scheduled services. This requires collection and analysis of data from multiple systems and sources (internal and external).
* Respond to questions families have about the calculated pre-service financial liability amounts.
* Maintain quality review audit scores that meet the specified performance expectation.
* Meet specified productivity standards/goals.
* Other special projects or duties as assigned by management.
* Assist with training and mentoring of staff.
* Additional skills required: Basic understanding of the health plan payment methodologies, and contract structure.
Senior Patient Access Specialist I - Centralized Authorization Team
All required duties of Senior Patient Access Specialist - Centralized Authorization Team and:
Researching the payer's appeal process, coordinating with internal and external parties to gather information needed for the appeal, and writing appeal letters. Assist with training and mentoring of staff. Continually monitor and review health plan publications.
Please click here to view the Physical Demands
All job offers are contingent upon successful completion of an occupational health assessment, drug screen, background investigation, and compliance with the U.S. Government Form I-9, Employment Eligibility Verification. Children's Minnesota requires proof of COVID-19 vaccine, and as recommended by the Centers for Disease Control and Prevention (CDC), immunity to vaccine preventable infectious diseases, prior to employment.
Children's Minnesota is committed to providing Equal Employment Opportunities to all applicants. EO M/F/Disability/Vet Employer.