Patient Access Rep FT Rep 2 (Tier2) - INP/OP Services and Quality

Job Title:  Tier 2 Patient Access Representative                 Department:  Patient Access

Reports to: Patient Access Manager                                        Revision Date: 9/16/2023

Grade Level: 17                                                                                 Status: Non-Exempt

Oswego Hospital and Off Sites, Days

$1,500.00 Sign On Bonus*

Job Summary:

The Tier 2 Patient Access Representative communicates with physician offices, staff, multiple service areas, and patients obtain demographic and insurance information for preregistration and registration, and scheduling purposes. Facilitates all components of the patient’s scheduled procedure prior to patient’s appointment/exam. Initiates and maintains authorization notifications and pre-authorization to avoid unnecessary liability practices. Ensures compliance of admission and discharge practices established by regulating agencies and third-party payers. Communicates Oswego Health’s financial policies and required documents to patients and identifies patients that require financial counseling. Collects on self-pay accounts, co-payments and deductibles. Identifies outpatient authorization requirements and medical necessity at time of patient visits. Other responsibilities include verifying benefits and order entry.

Duties/Responsibilities:

• Communicate with patients and families to provide information, guidance and assistance to patients as well as resolve customer complaints with excellent phone etiquette.
• Communicate with physician’s office staff, other members of health care team, and co-workers to ensure the flow of accurate and timely information, maintain collaborative relationships, and promote excellent customer service and quality patient care.
• Perform all duties related to scheduling, admission, switch-board, ED outpatient and SDC for registration requirements.
• Perform all required admission registrations including direct admission, labor and delivery, OP walk-in and other internal admission practices that need to be performed.
• Coordinate scheduling of service areas for patients requiring one or multiple tests.
• Identify and assign appointments via electronic orders for scheduled requests.
• Communicate schedule changes with scheduling group as well as technologist.
• Direct patient/provider complaints to appropriate medical staff members and follow up to ensure satisfactory resolution.
• Perform third party verification and payor eligibility requirements with knowledge of payer requirements, including No Fault and Workers Compensation Claims
• Initiate service authorizations for services requested from practitioners.  Record pertinent data for B/AR and Case Management use.
• Complete registration and perform scheduled appointments; provide information to maximize reimbursement and ensure dissemination of pertinent information to al providers.
• Follow physician entry procedures, including but not limited to, Doctor Other, multiple locations, and address changes.
• Verify insurance, obtain appropriate CPT and ICD10 codes for authorization, and benefit maintenance.
• Interview patient and/or guarantor to obtain and process accurate and complete patient information.  Obtain appropriate signatures on required forms and complete forms.
• Scan required patient information, insurance and state ID cards, Advanced Directives, and other registration forms; receive notices of service requisitions from providers; record pertinent data for claims submission.
• Identify appointments that need more attention and identify methods instructed for resolving difficult or conflicting accounts
• Provide patients with all required notices, including but not limited to, HIPAA, Health Care Proxy, and Patient Bill of Rights.
• Complete and process forms, including but not limited to, Medicare questionnaire and service authorizations.
• Complete daily, weekly, monthly tasks in a timely manner, inclusive of but not limited to financial support activities and designated department and organization competencies.
• Follow the hospital Credit and Collection policy.  Receive cash, credit card or other form of payments, apply transactions utilizing credit card machine and perform discounts as appropriate. 
• Follow the hospital Charity Care policy and provide information regarding our charity care policy as required.
• Read and stay up to date on all posted minutes and memos.
• Ensures all work areas are adequately stocked with supplies to provide quality services.
• Perform inpatient, outpatient, scheduled, and pre-registered patient registrations; Discharge patients when needed.
• Performs competencies related to switchboard, surgical services, emergency department, admissions, health services center lab and radiology, scheduling, and order entry.
• Export images as needed to CD’s; film/image sign out and release.
• Adhere to Accounting of Disclosures for patient record requests.
• Complete all competencies for the scheduled or covered area, including Surgical Center, Emergency Department, Lab and Radiology Registration, Urgent Care.
• Process incoming and outgoing mail per policy and instruction.
• Respond to administrative calls and/or complaints
• Operate Switchboard by taking incoming calls and transferring calls while maintaining a positive tone.
• Maintain operator logs
• Respond to third party visitors.
• Perform order entry of radiologic tests
• Follow code entry and ABN requirements per CMS guidelines
• Perform electronic ordering registration procedures, including courier procedures.
• Review orders/requisitions and diagnosis to ensure compliance and legality of order. Perform quality measures for all scheduled appointments including ABN requirements, valid requisition, and proper study ordered per diagnosis reasoning.
• Perform downtime procedures according to policy and procedure.
• Ensure accurate registration and compliance using all resources and education provided.
• Maintain knowledge of emergency codes and safety measures.
• Maintain knowledge of direct and transferred admissions as well as outpatient registration procedures.
• Assists with new orientation and training of new staff.
• Troubleshoot with radiologists, technicians, and providers as needed.
• Perform other duties as assigned.

Required Skills/Abilities (Unit Specific):         

• Skilled in PC/CRT data entry.
• Excellent service-oriented interpersonal skills; strong active listening ability.
• Excellent written and verbal communication skills.
• Ability to productively multi-task while working under stressful environment with multiple interruptions; detail oriented.
• Professionalism and business acumen appropriate for working with physicians, patients, and support staff.
• Proficient in standard computer programs, including Microsoft Office Suite, and EMR.
• Knowledge of general anatomy, medical terminology and/or 3rd party Insurance process preferred.

Education and Experience:

• High school diploma or GED required.
• Clerical and computer knowledge, including data entry, and ability to type 35 WPM required.
• Experience in customer service with strong communication skill required.
• 1 year experience in a customer service and/or medical office setting with knowledge of Medicare, Medicaid and other contract payers preferred.
• Familiarity or experience with Advance Beneficiary Notice, precertification, ICD10 coding, and/or CPT codes preferred.

Working Conditions:

• Functions by performing comprehensive requirements in multiple areas of Patient Access including (but not limited to): switchboard, surgical services, emergency department, admissions, health services center lab and radiology, scheduling, and order entry.

• Must be able to work occasional weekends.  Will be subject to rotating shifts to maintain required job knowledge, performance, and experience.
• Position requires working as needed at any of the Patient Access sites including: Hospital Cross training in other Access Departments and facilities.
• Requires extended periods of sitting and using computers and standard office equipment including, but not limited to phones, fax machines, printers, and scanners.
• Requires use of computer software including, but not limited to, Meditech, Clockwise, and electronic ordering system.
• Attendance ensures that job requirements are met.
• Ability to perform light lifting (up to 15 pounds) using proper body mechanics.
• Occasionally requires assembling, using, checking and maintaining equipment.
• Actively participates in cross-training, Quality Assessment programs, CQI, in-service programs, and mandatory classes; completes department specific requirements/competencies. Accepts assignments to other departments as assigned.
• Complies with DOH requirements for annual health assessments and required immunizations.

Pay Range; $18.19-$21.83

Employee salary is based on commensurate experience and other qualifications.

*Sign On for experienced candidates and Full Time positions.

The mission of Oswego Health is to provide accessible, quality care and improve the health of residents throughout Oswego County. As a nonprofit healthcare system that was established in 1881, Oswego Health is proud to continue to be one of Oswego County’s largest employers. More than 1,200 employees spread throughout its 17 locations, work for the Oswego Health system, which includes the 164-bed community hospital with a brand new Medical Surgical Unit, a 32-bed state-of-the-art psychiatric acute-care facility with multiple outpatient behavioral health service locations, The Manor at Seneca Hill, a 120-bed skilled nursing facility, and Springside at Seneca Hill, an independent retirement community.  The health system also operates Oswego Health Home Care, the only hospital-based certified home healthcare agency in the County as well as two outpatient centers, including the Fulton Medical Center, offering urgent care, lab, medical imaging, physical therapy, and occupational health services; and the Central Square Medical Center, offering urgent care, lab, medical imaging, and physical therapy services. In addition, Oswego Health includes the Oswego Health captive professional corporation, Physician Care P.C., providing physician services in orthopedics, cardiology, ENT, gastroenterology, breast care, audiology, general surgery, bariatrics, and primary care.

EQUAL EMPLOYMENT OPPORTUNITY

Oswego Health is committed to providing equal opportunity in all employment-related matters, without regard to race (including traits historically associated with race), creed, color, religion, sex/gender, national origin, age, marital or familial status, disability, pregnancy-related condition, sexual orientation, gender identity, gender expression, transgender status, citizenship status, ancestry, arrest/conviction record, military or veteran status, domestic violence victim status, genetic predisposition or carrier status, reproductive health decision making, relationship or association with a member of a protected category, or any other legally protected characteristic.  Decisions affecting your position including, but not limited to, recruitment, hiring, placement, promotion, transfer, compensation, benefits, training, tuition assistance, leaves of absence, disciplinary action, layoff/recall, and terminations will be made in accordance with this policy.