Oncology Patient Access Representative III

Sutter Health•Oakland, CA

About The Position

The Oncology Patient Access Representative III obtains information needed to register and financially clear patients, providing functional guidance to new employees and resolving issues using sound judgment and initiative. The role supports continuous improvement and provides issue identification, assessment, resolution, and technical support to ensure desired outcomes and compliance with the Electronic Health Record (EHR) and Sutter Health policies and procedures. The position oversees registration information and processes for Emergency, Ambulatory, Inpatient, and Outpatient service areas related to hospital billing and compliance. It completes or authenticates patient registration, verifies insurance and eligibility, processes orders and documentation, estimates and collects patient liabilities, maintains work queues, and supports patient experience and satisfaction. The role also reviews and clears EHR and Admission, Discharge, Transfer (ADT) work queues; corrects registration and billing errors; supports timely reimbursement; communicates with Patient Access and Clinical leadership; provides staff feedback and education; and creates process tip sheets and tracks system help tickets as needed.

Requirements

High school diploma or General Education Diploma (GED).
Two years of recent relevant experience.
General knowledge of patient access and financial counseling functions in acute and non-acute settings.
Working knowledge and understanding of insurance and medical terminology.
Knowledge of Emergency Medical Treatment and Active Labor Act (EMTALA) and consent laws.
Time-management skills and ability to handle frequent in-person patient contacts while accurately maintaining and documenting information in patient registration systems.
Ability to work accurately and efficiently in multiple computer systems, including patient registration and accounting systems, telephone consoles, document imaging and scanning systems, payment posting systems, proprietary payer websites, and data quality monitoring systems.
Verbal and written communication and active listening skills.
Accuracy and attention to detail.
Decision-making and problem-solving skills.
Ability to work concurrently on a variety of tasks and projects in a diverse environment.
Ability to meet or exceed targeted customer service, productivity, and quality standards.
Computer proficiency.
Ability to work with and maintain confidential information.

Responsibilities

Greet patients and family members and obtain or verify demographic, clinical, financial, and insurance information for patient registration and financial clearance.
Enter patient and guarantor information into registration and accounting systems, collect required signatures, and image or copy registration documents.
Authenticate and register patients who have registered through the Patient Access Center, and complete end-to-end registration through close-out for patients who have not registered.
Obtain and process signed physician orders.
Maintain assigned work queues.
Conduct insurance eligibility and benefit verification, referral and authorization activities, and financial education on designated accounts.
Calculate estimated patient liability, inform patients or guarantors, collect co-payments, deductibles, and deposits, and process payments for current or prior services.
Refer appropriate cases to financial counseling for follow-up and consultation.
Perform other duties as assigned, including cashiering, bed management, and communications operator tasks.
Enhance the patient experience through face-to-face and other communications, demonstrating knowledge of Sutter Health systems and services.
Support implementation of Shared Services programs, policies, initiatives, tools, and Patient Access processes.
Contribute ideas and actions toward continuous improvement of Patient Access processes within the area of influence.
Seek and respond to regular performance feedback and provide upward feedback as needed.
Maintain positive working relationships with other Shared Services teams and support strong peer-to-peer relationships within the Patient Access Client Location Team.
Perform revenue cycle tasks that support compliance and exceptional customer service, authenticate patient identity, and provide directional support when needed.
Maintain knowledge of applicable laws, regulations, standards, and Sutter policies and procedures, and behave honestly, ethically, and professionally.
Meet the department's monthly cash goal.
Review EHR work queues, resolve ADT issues, provide technical support, and clear ADT hospital billing work queues.
Identify and edit errors preventing insurance billing, release and correct work queue errors, and support efficient and timely reimbursement.
Work with Patient Access and Clinical department leadership and other appropriate parties to resolve and properly bill accounts.
Correct and log registration errors and notify Patient Access Management when the error rate exceeds the allowed standard.
Provide error feedback and education to Patient Access staff.
Create workflow process tip sheets to improve registration and revenue processes as needed.
Create and track system workflow service help tickets for EHR improvements, implementations, troubleshooting, and patient chart corrections.
Maintain collaborative relationships with appropriate Sutter affiliates to identify and explore help-ticket resolutions.