FLSA Status

Nonexempt

Job Role Summary

The Access Coordinator assists with scheduling patient appointments, provides coordination of referrals and acquire prior authorization as necessary to ensure optimal patient care. The position serves as a liaison between the call center, the clinical team, the patient, and the referral service/vendor to ensure needs are met within designated timelines. Proactively contributes to Eskenazi Health Mission: Advocate, Care, Teach and Serve with special needs emphasis on the vulnerable population of Marion County.

Essential Functions and Responsibilities

• Monitor assigned referral and prior authorization work queues to ensure that received referrals and prior authorizations are addressed in a timely manner, prioritizing urgent items appropriately.
• Schedule/reschedule appointments from referral work queues; relaying information to the patient
• Provide direct access to patients and providers with questions or concerns surrounding referrals or authorizations
• Utilize a database of prior authorization and utilization data to obtain prior approvals for services provided by the organization
• Develop an intricate knowledge of the specific characteristics of each insurance plan and their contact personnel to assist in job function.
• Determine client insurance eligibility through web-based applications and submit the prior authorization request for each client assigned who requires a prior authorization
• Communicate data with clinical staff to ensure that services provided within the parameters of the requests are completed as needed
• Enter prior authorization and referral outcome information into the electronic health record, closing the loop between ordering providers and patients.
• Communicate the outcome of the prior approval activity on a routine basis to the organization’s administration and to the clinical areas
• Understand Medicare regulations, Medicaid MRO, Medicaid Clinic Services and Commercial insurance related to inpatient and outpatient care, especially related to prior authorization process/requirements
• Facilitate the development of progressively more sophisticated and efficient referral and prior authorization process. Compile data to trend identified issues in referral and prior authorization
• Communicate effectively with internal and external contacts regarding current practices
• Document all inquiries accurately for medical, legal, and statistical purposes
• Assists with robust calls to patients to minimize patient no shows and maximize access
• Serves as a back-up for health center calls

Job Requirements

• High school diploma or equivalent (GED); Bachelor’s degree preferred.
• At least one year of experience in a healthcare setting preferred.
• Medical terminology, ICD-9/CPT coding and billing experience preferred.
• Spanish and English proficiency preferred.

Knowledge, Skills & Abilities

• Proficient in utilizing Microsoft Office, i.e. Excel, Word, and PowerPoint
• Excellent verbal and written communication skills
• Positive interpersonal skills and ability to work as part of a team
• Excellent organizational skills
• Knowledge of Medicaid and Medicare billing and regulations
• Must be goal oriented, capable of completing task within a given time frame, including overcoming any barriers that arise
• Self-starter with strong problem solving skills