Patient Access Services, Team Lead - Financial Clearance

Patient Access Services, Team Lead - Financial Clearance

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.

POSITION SUMMARY:

The Patient Access Services,Team Lead - Financial Clearance is responsible for helping oversee the operations of clerical support staff by managing and delegating financial interactions between patients, providers, and administration to improve customer service and employee satisfaction. They are also responsible for assigning tasks and ensuring completion, overseeing staff by acting as a resource for information and difficult situations, while maintaining open communication with staff, patients, providers and leadership to ensure operational goals are met. Highly focused position to ensure that the Patient Access staff possess a deep knowledge of what constitutes high quality service from the perspective of all customers. This position will collaborate with Patient Access leadership to ensure a proper and excellent patient experience is achieved. Responsible for the overall day-to-day administrative operations and delivery of the critical components of the front-end business.

RESPONSIBILITIES:

• Oversees and coordinates the flow of the daily functions of the Financial Patient Access Services Sub-department.
• Obtains and verifies authorizations and notifications for elective and emergent services via insurance payer website, facsimile, or phone.
• Assists clinical and marketing teams for departmental promotions.
• Stays abreast of changing third party payer criteria to aid in revenue capture as is relates to the hospital financial policy including compliance, guidelines and updates.
• Verifies and provides co-payment, deductible, co-insurance, and out-of-network amounts according to patient's health insurance plan and contractual agreement.
• Maintains cash collections, supply orders, and office equipment servicing.
• Reviews any denials and claims received with staff, determine root cause for preventative measures and assists with any questions or concerns they may have (i.e. educate and assist with obtaining backdated authorizations).
• Participates in performance improvement projects, ensures compliance of all work-related activities, data collection and other activities designed to enhance patient experience.
• Ensures a comprehensive understanding of all financial clearance roles and responsibilities.
• Works intra- and interdepartmentally to facilitate resolution of registration errors.
• Reports and attends departmental monthly meetings and provide updates on departmental initiatives, goals, and statistics.
• Responsible for creating and preparing unique and recurring reports or project as needed and assigned while keeping Patient Access leadership properly informed including daily point-of-service collections and revenue cycle initiatives.
• Collaborates with Patient Access leadership on performance expectations, regulatory and accreditation mandates.
• Acts as a liaison between SBSH and SBUH counterpart for revenue cycle related concerns.
• Assists patient with the completion of Medicaid applications by conducting on-site room and home visits and serves as a point-of-contact for patients who wish to apply for charity care.
• Oversees the financial process to maximize payment from commercial, managed care plans, and government programs.
• Tracks and manages single case rate agreements to maximize reimbursement.
• Attends Social Services and other Government agencies appointments.
• Works closely with Patient Access training team to ensure all new hires have necessary access to hospital systems.
• Maintains current knowledge base regarding insurance information and managed care guidelines; maintains knowledge base of designated networks based upon managed care contracts.
• Coordinates with Patient Access leadership to ensure appropriate staffing levels are met based on operational needs, handles and arranges coverage as needed and can be required to accommodate all shifts and locations across the department.
• Develops and maintains positive customer service with all patients, colleagues, visitors, and vendors by exercising utmost diplomacy and tact.
• 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 and/or contractual mandates and HR policy.
• 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-related duties as deemed appropriate by the Patient Access Services Manager and Director.

REQUIREMENTS, EXPERIENCE AND QUALIFICATIONS:

• Associate’s degree in Business or Healthcare required.
• Five (5) years’ experience in Revenue Cycle or Medical Office or Business Office required.
• Three (3) years of staff supervision and leadership experience required.
• Two (2) years' direct Patient Access experience required.
• Two (2) years of insurance authorization and eligibility experience are required.
• Customer service and support skills required.
• Strong communication, interpersonal, and multitasking skills required.
• CPT, ICD-10, and medical terminology experience required.
• Financial Aid, Medicaid, or Financial Coordinator knowledge is required.
• Must possess quantitative analytical skills and computer savviness including knowledge in Microsoft Office, Word, Excel, and PowerPoint, including external provider web portals.
• Must be able to multitask in a high stress fast-paced environment.
• Demonstrates exceptional attention to detail and accuracy in all tasks, ensuring high-quality results and minimizing errors.
• Capable of working independently with minimal supervision, demonstrating strong self-motivation and initiative with strong time management skills to meet deadlines.

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.

• 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 may be 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 and related facilities.

Anticipated Pay Range:

The starting salary range (or hiring range) for this position has been established based on relevant experience.

The above salary range (or hiring range) represents SBSH’s good faith and reasonable estimate of the range of possible compensation at the time of posting.

Your total compensation goes beyond the number in your paycheck!

• 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).

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

Company Overview:

Stony Brook Southampton Hospital as part of 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, duty 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 is 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.