Patient Access Services, Representative - Cancer Services

About the role

The Patient Access Cancer Services Representative plays a crucial role in the revenue cycle of Stony Brook Southampton Hospital, ensuring timely authorization of services, compliance with regulatory agencies, and delivering exceptional customer service.

Responsibilities

• Secures timely authorization of elective and emergent services
• Collaborates cross-departmentally and with physician offices to aid in pre-certification completeness
• Aids in proper reimbursement processes
• Provides high quality customer service to patients and colleagues
• Maintains and improves patient experience
• Handles administrative support functions related to all departments under Patient Access Services
• Collaborates with nursing staff, non-clinical staff, and other professionals to ensure an efficient process flow and adherence to regulatory and contractual mandates
• 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
• Maintains 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
• 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

Qualifications

• High School Diploma/GED and two (2) years’ experience in Revenue Cycle, Medical Office, or Business office
• One (1) year direct Patient Access experience
• One (1) year direct insurance verification/authorization experience
• Customer service and support skills
• Quantitative/analytical skills and computer savviness including Microsoft Office, Word, Excel, and PowerPoint, including knowledge of external provider web portals
• Exceptional attention to detail and accuracy in all tasks, ensuring high-quality results and minimizing errors
• Ability to multitask in high stress fast-paced environment
• Strong self-motivation and initiative with strong time management skills to meet deadlines
• Comprehensive knowledge to help in assisting patient in understanding medical insurance benefits
• Associate's degree strongly preferred
• CPT, ICD-10, and medical terminology experience strongly preferred