Pre-Access Representative

Job Description

SUMMARY

The Pre-Access Representative will be responsible for handling the flow of scheduling calls. The essential responsibilities include pre-registration, scheduling, obtaining accurate demographics, providing exam preparations, and collection of appropriate authorizations/ICD codes in a courteous and efficient manner. They will be responsible for completing accounts with eligible insurance and authorization and complete patient pre-registration for scheduled procedures. The Representative will verify the patient payer eligibility, benefits/coverage, and estimated payment responsibility, confirm authorization requirements and secure on the account. The Representative will complete pre-registration phone interviews, to include obtaining necessary pre-registration information, including demographics, insurance information, and Medicare MSPQ, with documentation completed in the electronic medical record account. During the pre-registration interview, the representative will notify patient of potential financial responsibility and collect payment via phone, review issued Medicare ABN (Advance Beneficiary Notification), provide direction to facility and registration desk, and educate the patient regarding what items are required as part of the patient's facility registration process.

STATUS: FULL-TIME

LOCATION: SLH MARKET 201 Market Street - Potsdam, NY 13676

DEPARTMENT: COMMUNICATION CENTER

SCHEDULE: MONDAY - FRIDAY 8:30AM-5PM

RESPONSIBILITIES:

Scheduling Procedures:

• Answers phones from patients/customers professionally and responding to patient/ customer complaints.
• Performs correct name inquiry and identifies patient according to policy and procedure without errors
• Schedules patients/customers based on scheduling guidelines and medical appropriateness.
• Receives a high volume of inbound calls with varying degrees of questions and concerns.
• Obtaining and collecting all necessary information from the patient/ customer to schedule and register the patient for an appointment.
• Consults with referring physician's office to ensure written and/ or electronic orders exist and obtain them as needed.
• Collects patient financial data, insurance, authorizations, and reference numbers.
• Collects complete demographic information of patient including address, phone number.
• Collects medical information to include patient complaint

Revenue Cycle:

• Views insurance card(s) and scans into computer system reviewing for mandatory precertification and/or other third party payer requirements
• Obtains Inpatient/ Observation patients precertification's
• Re works accounts to ensure accurate patient statuses
• Collects complete financial information to include payer name, identification number, group number, subscriber name, guarantor name and address, and precertification numbers
• Selects appropriate financial class and insurance code
• Performs online real-time eligibility verification and registration scrub via AHIqa and makes changes to registration errors accordingly and in a timely fashion
• Screens for insurance edibility via insurance websites, where appropriate
• Completes Medicare Secondary Payer Questionnaire for all Medicare-eligible patients
• Completes all admission forms required by Medicare
• Verifies third party payer benefits and Worker's Compensation according to departmental policy and procedure
• Collects any patient-pay balances such as copay, co-insurance, or deductible at time of registration
• Refers patient to Patient Financial Advocacy Program when appropriate and per departmental procedure
• Balances cash draw, completes cash receipt, issues patient receipts and secures safe daily with no exceptions

Registration/Pre-Registration:

• Interviews the patient and/or family member either in person or by telephone to collect demographic, financial, and medical information
• Performs correct name inquiry and identifies patient according to policy and procedure without errors
• Collects complete demographic information of patient including address, phone number, and employer
• Collects medical information to include patient complaint
• Explains consent information, obtains signatures, witnesses (legibly) with no omissions
• Obtains copy of patient identification document(s)
• Completes registration process within five minutes for preregistered patients and ten minutes for non-preregistered
• Contacts physician offices to obtain and confirm patient information
• Customer Service
• Practices proficient customer service skills by greeting and treating all patients and staff with respect and discretion
• Capable of empathizing with the circumstances of patients and families while maintaining and objective approach to the disposition of each account
• Provides and explanation of any patient wait and responds to all patient requests. Notified manager of any patient wait times longer than 15 minutes.
• Greets each patient and identifies self by name and role
• Notifies the manager of incidents, errors or patient complaints
• Maintains patient privacy and confidentiality at all times according to established procedures
• Assess environment for safety hazards, which could harm patients, visitors, or other hospital employee's and reports any found to facilities/housekeeping/manager
• Exhibits professionalism in appearance, speech and conduct

Development:

• Provide orientation and training of new staff
• Attend Patient Access Meetings, Training Sessions, etc
• Attend and actively participate in required and voluntary in-service education

MINIMUN QUALIFICATIONS

• High School Diploma or GED required

PREFERRED QUALIFICATIONS

• Associate's degree or higher in healthcare administration, business administration, or related field desired
• At least 1-3 years of customer service, administrative, and/or data entry experience preferred
• One to two years of previous experience in hospital related field preferred
• Experience with database software applications desired

UNION:

1199-200B SEIU (CPH) Clerical

Note: Not all per diem roles are union eligible

EDUCATION:

LICENSES / CERTIFICATIONS:

PHYSICAL REQUIREMENTS:

Sedentary - Sedentary roles are primarily office-based and require prolonged sitting (67-100% of the workday) with minimal physical effort and lifting limited to under 10 lbs. Fine motor skills are necessary for computer work, writing, and telephone use, supported by clear visual and auditory ability. Cognitive and emotional demands are high due to extended concentration, frequent interruptions, independent decision-making, and information processing. Although physical exposure is low, administrative areas within healthcare environments may occasionally involve contact with infectious agents. Some roles may require flexible hours, TB screening, or a valid driver's license.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee's physician or delegate will be considered for accommodations.

PAY RANGE:

$19.46 - $28.55

The posted pay range is a good faith representation of potential base pay for this position. It may be modified in the future and eligible for additional pay components. Individual annual salaries/hourly rates could vary based on position details and FTE. Pay is determined by considering factors including, but not limited to, experience, relevant qualifications, specialty, internal equity, locations, and contracts.

Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.