Patient Access Lead

What You'll Do

• Monitors operational performance and drives achievement of daily, weekly, and monthly operational objectives, including claim processing and reimbursement, collections, and key metrics expectations, recommending corrective actions as needed.
• Serves as escalation point for complex patient inquiries and concerns related to orders, referrals, authorizations, and billing matters, exercising independent judgment to facilitate resolution.
• Functions as a subject matter expert (SME) for Patient Access operations, assisting with claim volume management and providing guidance, consultation, and support to team members and cross-functional partners.
• Contributes to the development, implementation, and continuous improvement of Patient Access workflows, billing processes, and operational procedures to enhance efficiency, productivity, quality, patient satisfaction, and reimbursement outcomes.
• Ensures adherence to Standard Operating Procedures (SOPs), work instructions, and established quality standards across all non-clinical operations.
• Partners with leadership to ensure effective onboarding, training, coaching, and continuous learning initiatives for Patient Access team members and external sales partners, as needed.
• Collaborates proactively with Field Inventory Leadership and cross-functional teams to support timely product delivery and an exceptional patient experience.
• Maintains a thorough understanding of clinical documentation requirements and ensures accurate collection and review of necessary patient and claim information.
• Coordinates and prioritizes administrative and operational tasks that support business needs and the day-to-day activities of the Patient Access organization.
• Builds and maintains effective working relationships with internal departments, healthcare providers, patients, payers, and business partners to promote effective communication and operational success.
• Demonstrates professionalism and accountability by influencing positive team performance, driving engagement, and fostering customer service excellence.
• Oversees the Patient Service Center (PSC) administration functions, communicating operational disruptions, including power outages, severe weather events, or other circumstances impacting PSC operations, to appropriate leadership and support teams.
• Prepares and distributes operational reports and business reviews for key stakeholders, identifying trends and opportunities related to patient referrals, order activity, and service performance.
• Partners with the Revenue Cycle Management (RCM) and Payor Contract teams to ensure compliance with payor-specific requirements, including insurance verification, benefits review, prior authorization, claim processing, and patient financial responsibilities.
• Ensures patient services and billing activities are conducted in accordance with organizational compliance requirements, payer guidelines, and applicable accreditation standards.
• Adheres to all Breg policies, standard operating procedures (SOPs), and applicable healthcare regulations, including Health Insurance Portability and Accountability Act (HIPAA) and Food and Drug Administration (FDA) requirements.

What You Bring

• Associates degree in an applicable field of study required. Experience may be considered in lieu of degree.
• Minimum of 2 years of experience in a healthcare environment in a medical billing capacity, or another applicable role, required.
• Experience with medical insurance billing in a Durable Medical Equipment, Orthotics, Prosthetics and Supplies (DMEPOS) environment strongly preferred.
• Knowledge of EMR systems and understanding of where various data points and clinical information is located strongly preferred.
• Demonstrated ability to analyze data, identify patterns, and assess process effectiveness required.
• Previous medical records experience, including EMR navigation, general billing knowledge, Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) coding, and ICD-10 codes preferred.
• Knowledge of standard medical terminology, basic human anatomy, orthopedic diagnoses, and medical record format, content and medical documentation order preferred.
• Computer proficient to include web browser/internet search, Microsoft (MS) Outlook, Word, Excel, Teams and PowerPoint capabilities. Technical competence includes the ability to learn new software and systems.