Position Summary
At Stony Brook Medicine, our Patient Access Representatives are responsible for completing varied, diverse and specialized duties to support the Revenue Cycle, Compliance and Patient Experience by accurately and efficiently completing tasks in areas of Registration, Financial screening and verification, and Patient throughput.
Qualified candidates will demonstrate excellent communication skills, interpersonal skills, knowledge and understanding of patient care and effectively respond to changing patient needs by making decisions based on ethical principles and adhering to our high standard of excellence.
The Patient Access Lead Financial Clearance Representative will perform daily tasks aimed at validating patient insurance / benefit information while securing proper notification and/or authorization for a patient admission, test and/or procedure. The Patient Access, Lead Financial Clearance Representative is responsible for providing financial clearance, guidance and excellence in financial care to our patients and their representatives. The Lead representative will serve as Financial Clearance team super user and will work with the Supervisor to ensure productivity and quality standards are met consistently. Concurrently assists with timely completion of Hospital and Cancer Center Financial Clearance tasks.
Duties of a Lead Patient Access Financial Clearance Representative may include the following, but are not limited to:
Assists Supervisor in evaluating patient Financial Clearance issues; responsible for communicating resolution steps or changes in work effort to appropriate staff.
Work directly with staff to ensure workflow consistency and provide positive guidance and direction to staff on matters of Financial Clearance protocols and process flows.
Identifies and communicates staff development needs to Supervisor and provides training or re-education support.
Utilize worklists, reports, dedicated mailboxes and other resources to monitor productivity and registration quality. Adjust staff assignments to meet changing demands.
For all in scope surgical and outpatient services, ensure a patient's visit is financially secured by performing complete financial verification processes including, but not limited to; confirming all patient coverage, validating hospital participation, securing benefit information, authorizations, and/or referrals.
Ensure notifications are communicated to the insurance carrier for all non-scheduled services (Inpatient admissions and observation status) and collaborate with Care Management on authorization follow up requirements.
Maintains competency in policy and benefit nuances, revising job aids and reference guides as needed. Actively utilize insurance websites and other tools to ensure financial verification.
Accurately inform patients of all coverage, benefits and financial obligation benefits (including deductibles, copay / co-insurance, Out of Network benefits (if applicable), and out of pocket maximums). Refer patients to Financial Assistance Services, when appropriate.
Follow up on Emergency treatment and release encounters that require financial clearance and/or further investigation.
Supports the onsite registration areas with financial services ex
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