Pre-Access Representative at Rochester Regional Health – POTSDAM, New York

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.
Key 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
• Identifies an
• 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 educations
• Participate in performance improvement within the organization and department
Desired Attributes:
• 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

Knowledge / Skills / Abilities/ Essential Job Functions:
• Basic knowledge of the following:
o Medical Terminology
o EHR Programs (e.g. Meditech, eClinicalWorks, Medhost)
o ICD-10, CPT, HCPCS codes and coding processes
o Hospital billing processes and reimbursement
• Incumbent must possess superb customer service, teamwork, and conflict resolution skills
• Ability to learn and operate computer systems, printer, fax
• Strong attention to detail
• Efficient time management skills and ability to multi-task
• Excellent writing, oral, and interpersonal communication skills
• Exceptional organizational, planning, coordination and collaborating skills
• Strong understanding and comfort level with computer systems
• Ability to work under stress
• Work in fast-paced setting
• Critical thinking skills
• Knowledgeable of HIPPA regulations.
Required Attributes:
• High School Diploma or GED required

Licensure and or/Certification Requirements:
NA

PHYSICAL REQUIREMENTS: S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

PAY RANGE: $19.46 - $28.55

The listed base pay range is a good faith representation of current potential base pay for successful applicants. It may be modified in the future. Pay is determined by factors including experience, clinical licensure date, relevant qualifications, specialty, internal equity, location, and contracts.