Job Title: Tier 1 Patient Access Representative Department: Patient Access

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

Grade Level: 14 Status: Non-Exempt

Job Summary:

The Patient Access Representative communicates with physician offices, staff, multiple service areas, and patients to obtain demographic and insurance information for preregistration and registration on all patients for prompt and accurate patient billing. 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. 
• 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 third party verification and payer 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 forms using medical terminology, seeking assistance or using resources when necessary, to ensure accurate documentation of patient visit complaints and admission diagnosis descriptions.
• Follow physician entry procedures, including but not limited to, Doctor Other, multiple locations, and address changes. 
• Interview patient and/or guarantor to obtain and process accurate and complete patient information. Obtain appropriate signatures on required 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.
• Provide patients with all required notices, including but not limited to, HIPAA, Health Care Proxy, and Patient Bill of Rights.
• Complete daily, weekly, monthly tasks in a timely manner, inclusive of but not limited to financial support activities and designated department and organization competencies.
• Complete and process forms, including but not limited to, Medicare questionnaire and service authorizations.
• Perform outpatient, scheduled, and pre-registered patient registrations; Discharge patients when needed.
• Work on multiple electronic systems to identify online orders or other patient appointments.
• Collect cash, credit card or other forms of payments; perform discounts as appropriate. Open and close cashiering windows and balance payments.
• 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, maintaining 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
• Review orders/requisitions and diagnosis to ensure compliance and legality of order. Perform quality measures including correct diagnosis code, correct scheduled study, authorization requirements, provider entry, and other forms of quality procedures.
• Perform electronic ordering registration procedures, including courier procedures.
• Correctly identify patient scheduled appointments, visits and other patient types.
• 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.
• Ensures all work areas are adequately stocked with supplies to provide quality services.
• Perform other duties as assigned.

Required Skills/Abilities (Unit Specific):

• Skilled in PC/CRT data entry; proficient in standard computer programs, including Microsoft Office Suite, and EMR.
• Excellent service-oriented interpersonal skills; strong active listening ability.
• Excellent written and verbal communication skills.
• Ability to productively multi-task while working with intermittent interruptions and deadlines; detail oriented.
• Professionalism and business acumen appropriate for working with physicians, patients, and support staff.
• 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:

• Must be able to work alternate weekends and holidays with rotating shifts.
• Position requires working as needed at any of the Patient Access sites including: Hospital Cross trains 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; $15.45-$17/hr

Employee salary is based on commensurate experience and other qualifications.

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.