Job Purpose

The Team Lead, Patient Access will be the subject matter expert for insurance verification, registration edits, referrals, and authorizations. The Team Lead, Patient Access will support the Supervisor in the fulfillment of their responsibilities as well as support the team at the rep level including, reports, analytics, productivity, quality, daily monitoring, facilitating daily huddles, projects, and providing direction that aligns/supports departmental and associate targets and goals. In addition, this role must coordinate the training, ramp up training schedule, and mentorship for new hires that are onboarding onto the team.  

Duties and Responsibilities

• Works effectively with insurance companies to obtain/verify pre-certification/ authorization for services
• Ability to understand/interpret documented clinical information and relay pertinent medical/clinical information to the insurance company 
• Faxes to pre-certification request form to insurance company
• Maintains files and security of confidential information utilizing host system to scan and input data as per established procedures
• Verifies medical insurance information and documents in scheduling/registration modules
• Accurately enters and updates patient data, and other general data, into the computer system
• Patient intake; insurance verification, notification of copays/patient liability and confirmation of demographics 
• Maintain account work progress, including but not limited to updating authorization logs, account referral in EMR, authorization paperwork and issue reports
• Demonstrates knowledge of varied managed care insurance and regulatory guidelines
• Meets and maintains daily productivity/quality standards established in departmental policies 
• Uses the MPower workflow system, client host system and other tools available to them to collect payments and resolve accounts 
• Adheres to the policies and procedures established for the client/team 
• Communicate effectively with physician offices and patients.
• Place outbound call to patients with precertification notification.
• Work independently from assigned work queues
• Always maintain confidentiality 
• Maintain a professional attitude 
• Other duties as assigned by the management team 
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Understand and comply with Information Security and HIPAA policies and procedures at all times 
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties 

Qualifications

• High school diploma or equivalent required
• Preferred experience in a Team Lead or coordinator role
• Medical terminology knowledge required
• Minimum of 2-3 years of healthcare or physician's office related experience in obtaining and handling pre-authorizations
• Extensive knowledge of individual payor websites, including eviCore, Navinet and Novitasphere
• Knowledge of Medical Terminology, CPT Codes, Modifiers and Diagnosis Codes 
• Ability to work well individually and in a team environment
• Strong organizational and task prioritization skills
• Proficiency with MS Office. Must have basic Excel skillset 
• Experience with GE Centricity, EPIC PB, Allscripts, Cerner, preferred 
• Strong communication skills/oral and written 
• Strong organizational skills 
• Strong interpersonal skills, ability to communicate well at all levels of the organization 
• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses 
• High level of integrity and dependability with a strong sense of urgency and results oriented
• Excellent written and verbal communication skills required 
• Gracious and welcoming personality for customer service interaction 

Working Conditions

• Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes. 
• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.