Patient Access Services, Representative - Cancer Services

Stony Brook University•Town of Brookhaven, NY

6d•Onsite

About The Position

Stony Brook Southampton Hospital's Patient Access Services in a hospital setting encompasses many different roles and responsibilities. It is one of the most important and concentrated areas in healthcare. We are responsible for the delivery of the critical components of the revenue cycle, as well as keeping the hospital compliant with the many regulatory agencies, maintaining patient safety through correct patient identification practices and providing extraordinary customer service skills in situations that are often difficult. The Patient Access Cancer Services Representative is responsible for securing timely authorization of elective and emergent services, cooperate cross-departmentally and with physician offices to aid in completeness of pre-certification, aid in proper reimbursement and provide high quality customer service to patients and colleagues. This position is responsible for maintaining and improving patient experience as well as providing high quality customer service to patients and colleagues. Keeps abreast of current insurance regulations and handles administrative support functions related to all departments under the division of Patient Access Services. Collaborates with nursing staff, non-clinical staff, and other professional staff to assist in an efficacious process flow and to ensure adherence to regulatory and contractual mandates.

Requirements

High School Diploma/GED and two (2) years’ experience in Revenue Cycle, or Medical Office, or Business office required.
One (1) year direct Patient Access experience.
One (1) year direct insurance verification/authorization experience required.
Customer service and support skills required.
Quantitative/analytical skills and computer savviness including Microsoft Office, Word, Excel, and PowerPoint, including knowledge of external provider web portals.
Demonstrates exceptional attention to detail and accuracy in all tasks, ensuring high-quality results and minimizing errors.
Must be able to multitask in high stress fast-paced environment.
Capable of working independently with minimal supervision, demonstrating strong self-motivation and initiative with strong time management skills to meet deadlines.
Must possess comprehensive knowledge to help in assisting patient in understanding medical insurance benefits.

Nice To Haves

Associate's degree strongly preferred.
CPT, ICD-10, and medical terminology experience strongly preferred.

Responsibilities

Performs scheduling/registration functions and general office duties including word processing, copying, filing, faxing, answering phones and data entry.
Verifies insurance eligibility of all insured and self-pay patients.
Obtains and verifies authorization/notification for elective and emergent services via insurance payer website, facsimile, or phone.
Reviews, assesses, and evaluates patient registrations to ensure accuracy of demographic and financial information.
Responsible for maintaining add-on authorization and eligibility services.
Stays abreast of changing third party payer criteria to aid in revenue capture as it relates to the hospital financial policy.
Collaborates with physician offices and third-party payers concerning authorizations and eligibility.
Verifies co-payment, deductible, co-insurance, & out-of-network amounts according to patient’s health insurance plan and contractual agreement.
Refers self-pay patients to financial aid/self-pay representative.
Demonstrates advanced critical thinking skills and the ability to effectively navigate ambiguous patient scenarios.
Maintains data integrity of various tracking spreadsheets.
Manages the completion of monthly ERMA forms for Emergency Medicaid patients.
Stays abreast of changing third party payer criteria to aid in revenue capture as it relates to the hospital financial policy.
Maintains current knowledge base regarding insurance information and managed care guidelines; maintains knowledge base of designated networks based upon managed care contracts.
Collaborates with other departments to ensure the needs of the patient and department are met.
Demonstrates ability to utilize data retrieval insurance eligibility systems.
Reviews, assesses, and evaluates patient registrations to ensure accuracy of demographic and financial information.
Develops and maintains positive customer service with all patients, colleagues, visitors and vendors by exercising the utmost diplomacy and tact.
Manages RQA reports by resolving errors and producing corrected accounts.
Abides by documentation guidelines consistently.
Adheres to all company and department policies and procedures in confidentiality, regulatory or contractual mandates and HR policy.
Practices confidentiality and privacy protocols in accordance with hospital policies and HIPAA requirements.
Complies with departmental dress code and maintains a neat appearance.
Keeps current with departmental and hospital training requirements, including the completion of annual refresher courses.
Performs other department specific duties as deemed appropriate by Patient Access Leadership.