Patient Access Services Representative, Pre-Certification (Float position)

Patient Access Services Representative, Pre-Certification (Float position)

Stony Brook Southampton Hospital's Patient Access Services in a hospital setting encompasses many different roles and responsibilities. It is one of the most important and concentrated areas in healthcare. We are responsible for the delivery of the critical components of the revenue cycle, as well as keeping the hospital compliant with the many regulatory agencies, maintaining patient safety through correct patient identification practices and providing extraordinary customer service skills in situations that are often difficult.

BRIEF DESCRIPTION:

The Patient Access Services Pre-Certification Representative is responsible for securing timely authorization of elective and emergent services, cooperate cross-departmentally and with physician offices to aid in completeness of pre-certification, aid in proper reimbursement and provide high quality customer service to patients and colleagues. This position is responsible for maintaining and improving patient experience and providing high-quality customer service to patients and colleagues. Keeps abreast of current insurance regulations and handles administrative support functions related to all departments under the division of Patient Access Services. Collaborates with nursing staff, non-clinical staff, and other professional staff to assist in an efficacious process flow and to ensure adherence to regulatory and contractual mandates.

RESPONSIBILITIES:

• Performs scheduling/registration functions and general office duties including word processing, copying, filing, faxing, answering phones and data entry.
• Verifies insurance eligibility of all insured and self-pay patients.
• Obtains/verifies authorization/notification for elective and emergent services via insurance payer website, facsimile, or phone.
• Reviews, assesses, and evaluates patient registrations to ensure accuracy of demographic/financial information.
• Responsible for maintaining add-on authorization and eligibility services.
• Stays abreast of changing third-party payer criteria to aid in revenue capture as it relates to the hospital's financial policy.
• Collaborates with physician offices and third-party payers concerning authorizations and eligibility.
• Verifies co-payment, deductible, co-insurance, & out-of-network amounts according to patient's health insurance plan and contractual agreement.
• Refers self-pay patients to financial aid, self-pay representative.
• Develops and maintains positive customer relationships with all patients, colleagues, visitors, vendors, etc.
• Demonstrates advanced critical thinking skills and the ability to effectively navigate ambiguous patient scenarios.
• Maintains current knowledge base regarding insurance information and managed care guidelines and knowledge-based of designated networks based upon managed care contracts.
• Collaborates with other departments to ensure the needs of the patient and department are met.
• Manages RQA reports by resolving errors and producing corrected accounts.
• Abides by documentation guidelines consistently.
• Adheres to all company and department policies and procedures in confidentiality, regulatory or contractual mandates and HR policy.
• Practices, confidentiality and privacy protocols in accordance with hospital policies and HIPAA requirements.
• Complies with departmental dress code and maintains a neat appearance.
• Keeps current with departmental and hospital training requirements, including the completion of annual refresher courses.
• Performs other department-specific duties as deemed appropriate by Patient Access Leadership.

REQUIREMENTS/EXPERIENCE AND QUALIFICATIONS:

• High School Diploma/GED and two (2) years combined experience in Revenue Cycle or Medical Office, Business office required.
• Associate's Degree strongly preferred.
• One (1) year of direct Patient Access experience required.
• One (1) year of direct insurance authorization and eligibility experience is required.
• Customer service and support skills required.
• Strong communication, interpersonal, and multitasking skills required.
• CPT, ICD-10, and medical terminology experience strongly preferred.
• Must possess quantitative analytical skills and computer savviness including; Microsoft Office, Word, Excel, and PowerPoint, including knowledge of external provider web portals.
• Demonstrates exceptional attention to detail and accuracy in all tasks, ensuring high-quality results and minimizing errors.
• Must be able to multitask in a high-stress fast-paced environment.
• Capable of working independently with minimal supervision, demonstrating strong self-motivation and initiative with strong time management skills to meet deadlines.
• Possesses comprehensive knowledge to help in assisting patients in understanding medical insurance benefits.

PHYSICAL DEMANDS:

• Prolonged periods of standing, walking, and sitting.
• Commuting to hospital and offsite facilities required.
• Must be able to lift up to 25 pounds.
• Possible exposure to various illnesses and diseases.

Special Notes: Resume/CV should be included with the online application.

• Stony Brook Medicine is a smoke-free environment. Smoking is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises.
• All Hospital positions maybe subject to changes in pass days and shifts as necessary.
• This position may require the wearing of respiratory protection, which may prohibit the wearing of facial hair.
• This function/position maybe designated as “essential.” This means that when the Hospital is faced with an institutional emergency, employees in such positions may be required to remain at their work location or to report to work to protect, recover, and continue operations at Stony Brook Medicine, Stony Brook Southampton Hospital and related facilities.

Prior to start date, the selected candidate must meet the following requirements:

• Successfully complete pre-employment physical examination and obtain medical clearance from Stony Brook Southampton Hospital's Employee Health Services*
• Complete electronic reference check with a minimum of three (3) professional references.
• Successfully complete a 4 panel drug screen*
• Meet Regulatory Requirements for pre-employment screenings.
• Provide a copy of any required New York State license(s)/certificate(s).

Failure to comply with any of the above requirements could result in a delayed start date and/or revocation of the employment offer.

• The Human Resources department will be responsible for any fee incurred for examination.

Company Overview:

Stony Brook Southampton Hospital as part of the Stony Brook Medicine provides direct access to the highest level of academic-based medical care. Located in the heart of the village of Southampton, two hours from New York City, the hospital provides healthcare services to a diverse community of year-round residents, second homeowners and vacationers. The population, about 75,000 in the winter months, increases sharply to more than 300,000 in the summer. Stony Brook Southampton Hospital has been recognized as a Long Island Top Workplace by Newsday among large employers (defined as having 500 employees).

StaffCo is a Professional Employer Organization, commonly referred to as a PEO, duly organized and registered under the New York Professional Employer Organization law.. StaffCo and SUNY have entered into a professional employer agreement under which StaffCo is the employer of Stony Brook Southampton employees and responsible for employment, including, promotions, disciplines, terminations, the day-to-day direction and supervision of work, as well as labor relations and collective bargaining.. StaffCo is fully responsible for providing all payroll and human resource services, including the payment of wages, collecting and reporting payroll taxes and maintaining any and all employee benefits. SUNY Stony Brook Hospital is responsible for the operation of the hospital and provision of health care and is the co-employer as is necessary to conduct its responsibilities and for related licensure, regulatory or statutory requirements and obligations.

Given StaffCo’s employment responsibilities, it is deemed the “employer” for employment and labor law purposes. Thus, the employees are private sector employees of StaffCo, not public sector employees of SUNY. The private sector nature of the StaffCo employees has been approved by NYS Civil Service and upheld in a decision by the US National Labor Relations Board.

Stony Brook Medicine is committed to excellence in diversity and the creation of an inclusive learning and working environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws.

Stony Brook Southampton Hospital, consistent with our shared core values and our intent to achieve excellence, remains dedicated to supporting healthier and more resilient communities, both locally and globally.