- 23-Dec-2020 to Until Filled (EST)
- West Columbia, SC, USA
- Full Time
The Patient Access Nurse functions as an integral member of a multidisciplinary clinical team which manages the care of patients. Patient Access Nurse will verify patient's health benefits and coverage for infusion services. The Patient Access Nurse works closely with the Intake Coordinator to process new referrals timely. Ensures accurate and complete verification of insurance benefits. Communicates insurance benefits to include any co-pay or co-insurance to the Patient Account Specialist/Admin Assistant. Works closely with clinical staff and Reimbursement team in providing and promoting customer service, process flow, operational integrity, quality care and process improvement along with high service standards. Represents self in a professional and ethical manner at all times.
- Two (2) plus years of medical insurance case management experience required.
- Medical terminology and coding experience required.
- High School Diploma or equivalent.
- Graduate from an accredited school of nursing with RN or LPN degree.
- Experience in a clinical specialty involving infusion therapy desirable.
- A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers.
- Must be able to assume a flexible work schedule.
- Strong organizational, communication and problem solving skills.
- Excellent internal and external customer service.
- Must have excellent interpersonal skills in handling interactions with Palmetto Infusion staff, other agencies, groups, patients and families.
- Competent in use of company email as means of communication, accessing the company website to view company policies and electronic medical records.
- Competent in the use of company self-service payroll software (time and attendance, benefits, pay statements).
- Competent in the use of Microsoft Office products and the ability to navigate Internet Explorer. Proficient in typing, word processing (Microsoft Office/Express, Word, Excel), and familiar with office equipment.
- Proficient in the operation of the current EMR software.
- This position requires a knowledge of, and sensitivity to, cultural and language differences.
- Must have the ability to perform basic mathematical computations. Ability to apply concepts such as fractions, percentages, ratios and proportions to practical situations.
- There are a number of deadlines associated with this position. The employee must also multi-task and interact with a wider variety of people on various and, at times, complicated issues.
- The physical demands described here are representative of those that must be met by an employee to successfully perform the primary functions of this job. While performing the duties of this job, the employee may be required to frequently stand, walk, sit, bend, twist, talk and hear. There may be prolonged periods of sitting, keyboarding, reading, as well as driving or riding in transport vehicles. The employee must occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this job include reading, distance, computer, and color vision. Talking and hearing are essential to communicate with patients, vendors and staff.
- Must be able to work as a team member and develop productive and cooperative working relationships with all members of the Palmetto Infusion team.
ESSENTIAL DUTIES, FUNCTIONS & RESPONSIBILITIES
- Provides timely acceptance and completion of new referrals.
- Obtains patient data from referring physician office for support of medical necessity; ensures data integrity.
- Reviews payor medical policy to determine medical necessity based on payor guidelines and/or FDA indications.
- Understands Medicare coverage principles and requirements.
- Performs insurance verification for new patients.
- Provides clinical knowledge and acts as a clinical resource to non-clinical staff members.
- Documents in the EMR system clinical rational supporting approving or denying a service based on payer medical polies and/or FDA indications.
- Provides the initial clinical review to determine medical necessity based on the payer's medical policy and/or FDA indications, primary for new referrals.
- Assists with evaluating the financial appropriateness of new referrals.
- Follows the Intake process timeline for processing new referrals.
- Obtains initial authorization and reauthorization as applicable.
- Completes the insurance verification in the EMR software and ensures the documentation obtained from the payor's website is scanned into the patient medical record.
- Obtains a Letter of Medical Necessity (LMN), when required, from select payors.
- Contacts case management/third party administrator/payor representative.
- Maintains knowledge of reimbursement principles and pricing parameters.
- Identifies and coordinates materials to be sent to payor source.
- Provides and documents on-going communication with payor case managers for updates/changes/authorizations.
- Maintains courteous demeanor at all times.
- Communicates with peers, supervisors, and other employees in a non-threatening manner.
- Takes initiative to present ideas and suggestions to leadership.
- Demonstrates ability to maintain calm under pressure.
- Demonstrates ability to cope with changing environment.
- Maintains knowledge and proficiency in medical practices through continuing education, staff meetings, and workshops, and home study.
- Participates in the orientation/training of other staff as requested.
- Supports the marketing efforts of PI by assisting the sales team and providing educational programs to referral sources as requested.
- Participates in Performance Improvement processes.
- Performs other duties and projects as assigned.
In performance of their respective tasks and duties all employees and contract employees of Palmetto Infusion are expected to conform to the following:
- Adhere to all professional and ethical behavior standards of the healthcare industry.
- Display a neat, clean and professional appearance at all times.
- Interact in an honest, trustworthy and dependable manner with patients, employees and vendors.
- Possess cultural awareness and sensitivity.
- Maintain a current insurable driver's license.
- Maintain professional licensure, certification and health requirements as required for this position.
The work environment characteristics described here are representative of those an employee encounters while performing the primary functions of this job. Normal office conditions exist, and the noise level in the work environment can vary from low to moderate. Limited overnight travel may be required from time to time.
All employees must uphold the confidentiality of protected health information and follow all HIPAA policies. This position has access to sensitive information and a breach of information may be grounds for immediate termination.
Disclaimer: The information on this position description has been designed to indicate the general nature and level of work performance by employees in this position. It is not designed to contain, or be interpreted as, a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position. Employees will be asked to perform other duties as needed.