Kelly Services Patient Access Nurse in West Columbia, South Carolina
Kelly Services is recruiting for an opportunity in the West Columbia, SC area for a Patient Access Nurse.
If you qualify please forward your resume to firstname.lastname@example.org
Title: Patient Access Nurse
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.
Qualifications – Required:
• Two (2) plus years of medical insurance case management experience required.
• Medical terminology and coding experience required. Education:
• LPN or RN Degree
• Graduate from an accredited school of nursing with 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. Interpersonal Skills:
• 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 (Word, Excel, Outlook, PowerPoint) and the ability to navigate Microsoft Edge and Google Chrome. Proficient in typing 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, and reading. The employee may occasionally lift and/or move up to 25 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. Other Skills:
• Must be able to work as a team member and develop productive and cooperative working relationships with all members of the Palmetto Infusion team.
• Must adhere to and comply with the Health Insurance Portability and Accountability Act (HIPAA) at all times.
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 INTA 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 pay or source.
• Provides and documents on-going communication with payor case managers for updates/changes/authorizations.
• Always maintains courteous demeanor.
• 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.
Why Kelly ® ?
You’re looking to keep your career moving onward and upward, and we’re here to help you do just that. Our financial staffing experts will connect you with premier companies for opportunities where you can learn, grow, and thrive. Jobs that fit your skills and experience, and most importantly, fit right on your path of where you want to go in in your career. It all adds up.
About Kelly ®
At Kelly, we’re always thinking about what’s next and advising job seekers on new ways of working to reach their full potential. In fact, we’re a leading advocate for temporary/nontraditional workstyles, because we believe they allow flexibility and tremendous growth opportunities that enable a better way to work and live (plus, did we mention we provide a ton of benefits ?). Connecting great people with great companies is what we do best, and our employment opportunities span a wide variety of workstyles, skill levels, and industries around the world.
Kelly is an equal opportunity employer committed to employing a diverse workforce and providing accommodations for people with disabilities in all parts of the hiring process as required under its Employment Accommodation Policy. Kelly will work with applicants to meet accommodation needs that are made known to Kelly in advance.