Access Lead- UPMC West Shore

Purpose:

Coordinate and lead the daily functions of the designated work area along with providing direction and support to staff as needed. Escalates any concerns or problems to management when necessary. Facilitate the completion of all statistical reporting and data analysis to ensure UPMC guidelines are being supported. Serve as the primary information source and advocate for financial matters on site.

Responsibilities:

• Support and contribute to UPMC core values and guiding principles of Your Care.

• Our Commitment and abide by all UPMC departmental policies, procedures and goals in the process of performing all job responsibilities. Incorporates acts of dignity and respect in daily interactions.

• Serve as an advocate, resource, troubleshooter, and designated leader at specific work sites.

• Represents Management and is empowered to make decisions.

• Responsible for training new staff and orienting to department work area. Provide ongoing education and communication as necessary.

• Provide feedback on a regular basis to management about all personnel, department issues and concerns for areas of direct responsibility.

• Monitor patient flow and respond to changes in workload, patient volume, and staffing levels, planning services accordingly.

• Ensure precertification requirements have been met prior to treatment.

• Update patient demographic and insurance information in the system as necessary.

• Verify insurance benefit information with all available carriers via electronic verification system or telephone if not previously completed.

• Interact with the clinical staff and/or ancillary departments to resolve reimbursement issues.

• Advise the clinical staff of the need for a possible referral to a participating health care facility when appropriate.

• Works various revenue reports within established time frames.

• Takes action accordingly to ensure a successful billing process.

• Performs in accordance with system-wide competencies/behaviors.

• Performs other duties as assigned.

• High school diploma or GED and at least 3 years of experience in a related fiscal/admissions/registration function, or Associate degree and 1 year experience; or an equivalent combination of education and experience required.

• Medical terminology, third party health care coverage experience and strong understanding of managed care regulations are required.

• Strong interpersonal, organizational and communication skills and be able to remain professional and courteous when dealing with sensitive issues and stressful circumstances.

• Ability to effectively problem solve and make independent decisions.

• Prior working experience on personal computers and various office equipment.

• Knowledge and skills necessary to provide care and/or interact appropriately with all ages of patients.

• Possess the ability to assess data reflective of the patient's status and interprets the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs.

• Provide the care needs as described in the department's policy and procedure.Licensure, Certifications, and Clearances:

• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran