Grade Level: 19Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Status: Non-Exempt

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Job Summary:

The Patient Access Representative Team Lead is responsible for staffing and operational activities within patient access, including enforcing departmental policies, practices and procedures, employee training and orientation, reporting departmental concerns, and providing recommendations for improvement. 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. Performs quality control to ensure patients admission, scheduled study or walk-in visit is compliant and accurate. Communicates Oswego Health’s financial policies and required documents to patients and identifies patients that require financial counseling. Responsible for understanding authorization and medical necessity at time of scheduling the appointment, obtaining authorization for studies at time of scheduling the appointment per insurance requirements and cancelling if it is not authorized.

Duties/Responsibilities:

Coordinate re-scheduling requests
Manage the 1800 notify list for cancellations / cover the rescheduling line
Scheduling Quality (review future appts for scheduling inaccuracies)
Be the liaison between Imaging tech/support and Scheduling
Cover call ins for authorizations or imaging scheduling
Facilitate competencies/perform Scheduler productivity
Assist in performance measures and improvements
Keep scheduling protocols updated and used to minimize calls to techs and other imaging staff
Schedule Diagnostic Mammo/Ultrasound

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.
Observe operation metrics to ensure department meets organizational goals including, but not limited to Service Level Agreements and budgetary guidelines.
Perform third party verification and payer eligibility requirements with knowledge of payer requirements, including No Fault and Workers Compensation Claims
Initiate required service authorizations. Document pertinent data accurately in ARM.
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 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.Â
Interview patient and/or guarantor to obtain and process accurate and complete patient information.Â Obtain appropriate signatures on required forms.
Collect cash, credit card or other forms of payments; perform discounts as appropriate. Open and close cashiering windows and balance payments.
Adhere to Accounting of Disclosures for patient record requests.
Perform downtime procedures according to policy and procedure.
Independently identify appointments that need further attention and identify methods for resolving difficult or conflicting accounts.
Complete accurate registration and perform an accurate scheduled appointment to provide information to maximize reimbursement and ensure timely and thorough information to all other providers and users of the patient data.
Verify insurance, obtain appropriate CPT and ICD10 codes for authorization, and benefit maintenance.
Perform quality measures including, but not limited to, ABN requirements, requisition is on file and valid, proper study ordered per diagnosis reasoning.
Pre-register scheduled patients; maintain changes in patient information; ensure insurance authorization requirements are met at time of scheduling.
Inform provider offices of authorization requirements per insurance plan and medical necessity per CMS guidelines for designated studies.
Take calls for admission, relating information from the caller to admission/authorization staff.
Perform all required admission registration including direct admission, labor and delivery, OP walk-in and other internal admission practices that need to be performed.
Coordinate scheduling of service areas for patients requiring one or multiple tests. ]
Identify and assign appointments via electronic orders for scheduled requests.
Communicate schedule changes with scheduling group well as technologist.
Direct patient/provider inquiries or complaints to the appropriate medical staff members and follow up to ensure satisfactory resolution.

Required Skills/Abilities (Unit Specific): Â Â Â Â Â Â Â Â

Clerical skills and proficiency in basic computer software, including Microsoft Office Suite.
Skilled in PC/CRT data entry.
Knowledge of medical terminology, 3rd party Insurance, registration and revenue cycle preferred.
Professionalism, interpersonal skills with ability to establish consultative relationships.
Excellent written and verbal communication skills, time-management skills, and ability to work under conditions of intermittent interruptions.

Education and Experience:

High school diploma or GED required.
Associates degree in Business Administration preferred.
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:

Requires extended periods of sitting and using computers.
Requires remaining current with all Patient Access implementations and education, and emails.
Must be able to work weekends pending position location and holidays if needed, with rotation of shifts to ensure performance and knowledge of all areas meet requirements.
Position requires working as needed at any of the Patient Access sites including based on position location.
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.

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Pay Range: $19.80-$23.76/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.

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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.

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