Patient Access Rep PT Shift 1 -ED - Oswego Health

Job Title:  ED Patient Access Representative                       Department:  Patient Access

Reports to: Patient Access Manager                                        Revision Date: 10/10/2024

Grade Level: 15                                                                                 Status: Non-Exempt

Job Summary:

The Patient Access Representative communicates and will work with physician offices, staff in multiple service areas, and patients. Patient Access Reps are responsible to obtain accurate demographic and insurance information for preregistration and registration. Performs multiple types of hospital outpatient and hospital inpatient-admission registration procedures as well as being in compliance with regulating agencies and third party payers. Identify patient due balances by understanding the insurance plan benefit process and collecting the appropriate amount due based on collection policies. Admission and discharge practices. Provides guidance, assistance, and information, to patients, and ensures understanding of all Oswego Health’s financial policies and other required documents. 

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
• Complete complex bed side patient registration
• Must be able to maneuver a work station on wheels through patients’ rooms
• Initiate service authorizations for services requested from practitioners.  Record pertinent data for B/AR and Case Management use.
• Complete daily/weekly/monthly tasks including, but not limited to financial support activities and designated department/organization competencies.
• 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 Primary Care physician entry procedures, including but not limited to, Doctor Other, multiple locations, and address changes. 
• Interview patient, representative of patient and/or guarantor to obtain and process accurate and complete patient information.  Obtain appropriate signatures on multiple required forms and notices, including but not limited to, HIPAA, Health Care Proxy, and Patient Bill of Rights
• 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.
• Perform inpatient and outpatient, scheduled and pre-registered registrations; Discharge patients when needed.
• Collect cash, credit card or other forms of payments; perform discounts as appropriate. Open and close cashiering windows and balance payments.
• Communicate Financial Assistance and guidance by presenting information for al. patients.
• Respond by procedural resources to emergency panels and emergency calls and demonstrate knowledge of codes and safety measures
• Complete all competencies for the scheduled or covered area.
• 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.
• 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.  Reviews registrations for completeness & correctness.  Utilizes worklists to conduct incomplete registration, verification or ineligible insurance follow up. 
• 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.
• Ability to type 30/40 words per minute
• 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
• Associates Degree not required but preferred
• Data Entry and computer knowledge 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:

• Requires remaining current with all Patient Access implementations and education, and emails.
• 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: Switchboard, and other potential hospital cross training needs in other Access Departments and facilities.
• Requires extended periods of sitting and using computers, working with work station on wheels and standard office equipment including, but not limited to phones, fax machines, printers, and scanners.
• Requires periods of standing and registering patients in the patient care area.
• Requires use of computer software including, but not limited to, Meditech, Clockwise, Insurance web sites, electronic eligibility 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; $17.00-20.40/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.