We Are Hiring!

At Riverside, everyday brings new and exciting challenges. You can expect an interesting environment where you’re part of making sure our organization is running optimally and safely, helping keep the community healthy. We provide the kind of paid training and opportunities that long-term careers are built on and we recognize hard workers who strive to make a difference. You will be able to succeed in our close-knit, safety-focused culture working together as a team. The careers we offer are meaningful because the work we do matters. Join us!

FTE: 1.000000

Shift: Days

Location: Hoover

Summary:
The Benefits and Authorizations Patient Access Associate III must be competent in the following: registering, reviewing and analyzing insurance/Medicare/Medicaid compliance and strong customer service skills. The Benefits and Authorizations Access Associate III must have the ability to work independently in a fast-paced environment. Interacting in a customer-focused and compassionate manner to ensure patients and their representatives; needs are met, and that they understand the hospital’s revenue expectations, including resolution through various payment options.

Experience/Education Requirements:

• High School Diploma or equivalent.
• Computer literacy.
• Medical Terminology preferred.
• Office or other clerical experience preferred.
• Ability to read and write in English. Verbal skills required to interact on the telephone or in person in a courteous and respectful manner.
• Ability to do general arithmetic.
• Prior experience in obtaining authorizations field preferred.
• Prior knowledge of payor regulatory compliance and HIPAA Privacy and Security requirements.
• Detail oriented, committed to accuracy, and ability to problem solve.
• Understanding of the hospital revenue cycle.
• Preferred authorization experience in surgical specialty, pain, neuro/ortho

License or Certification Requirements:

• None

Responsibilities:

• Reviews call software consistently and makes necessary staffing adjustments to meet volumes.
• Attends all mandatory continuing education and department meetings.
• Reviews email timely to keep abreast of current information.
• Reviews and maintains assigned work queues according to department specific goals.
• Reviews physician orders and other documentation against payer coverage and medical necessity criteria, uses screening software to determine whether services being provided meet third-party requirements for payment, contacts physicians as necessary for additional clinical information; informs physicians about payer requirements, initiates Medicare ABN processes as appropriate.
• Explains payer policies to patients and financial responsibility within the revenue cycle to assist in meeting other internal, regulatory and payor requirements.
• Documents financial expectations of payer and medical necessity verification.
• Refers appropriately to Patient Financial Services.
• The Patient Access Associate III will accurately collect, analyze and record demographic, insurance/financial and clinical data from multiple sources, and obtain other information and signatures as necessary for registration, billing and payor authorizations.
• The Patient Access Associate III will maintain all assigned work queue's in a timely manner.
• Reviews Physician Orders and other documentation against payer coverage and medical necessity criteria.
• Uses screening tool software to determine whether services being provided meet third party requirements for payment.
• Contacts Physicians as necessary for additional clinical information; informs physicians about payer requirements.
• Communicates effectively and in a professional manner with peers, providers, clinical staff, insurance companies and other team members.
• Accurately and thoroughly documents required information pertinent to the authorization process.
• Refers patients and their representatives to Patient Financial Services.
• Initiates the authorization process for the Riverside Medical Group, communicating clinical information needed for insurance company.
• Follows HIPAA payer and other and other applicable regulations and standards.

Riverside Healthcare is revolutionizing care using leading-edge technology to diagnose and treat patients. We are ranked top in the nation for performance in neurosurgery, orthopedics, and heart surgery and have also been named one of the nation's 100 Top Hospitals by Truven Health Analytics seven times. Riverside is nationally recognized for our specialty programs in obstetrics, trauma, oncology, rehabilitation, geriatrics, occupational health, psychiatric services, and treatment of alcohol and chemical dependency, as well as patient safety. We combine innovation and convenience at state-of-the-art facilities located in communities throughout the greater Kankakee area.

Riverside Medical Center proves that truly progressive medicine is being delivered in Chicago's southwest suburbs and East Central Illinois. Join a team that is not only concerned with providing the best care possible but also with offering a work environment of advancement and growth. Riverside is a place that embraces a culture where opinions count and dedications is respected, where superior performance is rewarded with competitive salaries and excellent benefits.

Other information:

Exposure/Sensory Requirements

Exposure to:
Chemicals: None
Video Display Terminals: Average
Blood and Body Fluids: Performing ER and Admitting registrations have the potential to be exposed.
TB or Airborne Pathogens: Performing ER and Admitting registrations have the potential to be exposed.

Sensory requirements (speech, vision, smell, hearing, touch):
Speech: Required to communicate during presentations/training, telephone communication, and facilitate meetings.
Vision: Needed to read memos and literature, close vision (ability to adjust focus).
Smell: NA
Hearing: Needed for telephone communication, meetings, alarms and listening to employee concerns.
Touch: Needed to write, computer entry, filing.

Activity/Lifting Requirements

Average Hours per Week: 40

Shift: Varies

Percentage of time during the normal workday the employee is required to:
Sit: 50-88%
Twist: 5%
Stand: 1%
Crawl: 0%
Walk: 12-50%
Kneel: 0%
Lift: 0%
Drive: 0%
Squat: 0%
Climb: 0%
Bend: 5%
Reach above shoulders: 2%

The weight required to be lifted each normal workday according to the continuum described below:
Up to 10 lbs: Frequently
Up to 20 lbs: Frequently
Up to 35 lbs: Occasionally
Up to 50 lbs: Occasionally
Up to 75 lbs: Not Required
Up to 100 lbs: Not Required
Over 100 lbs: Not Required

Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.):
Carrying materials such as charts and labels waist high and for approximately 20 feet.

Maximum consecutive time (minutes) during the normal workday for each activity:
Sit: 30
Twist: 1
Stand: 5
Crawl: 0
Walk: 5
Kneel: 0
Lift: 0
Drive: 0
Squat: 0
Climb: 0
Bend: 0
Reach above shoulders: 1

Repetitive use of hands (Frequency indicated):
Simple grasp up to 10 lbs. Normal weight: 5-10# frequent
Pushing & pulling Normal weight: <50#>
Fine Manipulation: Computer keyboard, writing, calculator.

Repetitive use of foot or feet in operating machine control: Not Required

Environmental Factors (Time Spent) :
Inside hours: 8
Outside hours : 0

Temperature: Normal Range
Lighting: Average
Noise levels: Average
Humidity: Normal Range
Atmosphere:

Special Hazards :
Protective Clothing Required: None