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Access Call Center Representative

3 months ago

Silver Spring, Maryland, United States Children's National Hospital Full time
Schedule, pre-certify, verify and document procedures for ancillary services and minor surgical treatments. Serve as a liaison between call center, clinics, and external providers. Provide accurate documentation following all established protocols to register and schedule patients' appointments by telephone. Ensure that appointments are scheduled in accordance within departmental guidelines. Responsible for obtaining and validating patient information from various sources and to ensure information entered into the computer management system is accurate. Perform responsibilities within established customer service standards. Provide assistance to other employees within their department as well as other departments.

Qualifications:
Minimum Education
High School Diploma or GED (Required)
Associate's Degree (Preferred)

Minimum Work Experience
3 years Experience performing patient registration and scheduling, medical insurance screening and verification (Required)

Required Skills/Knowledge
Excellent customer service skills
Demonstrated problem solving and critical thinking skills
Computer knowledge necessary
Microsoft Office experience required
Must complete Patient Access training curriculum and pass all competency assessments, including the ability to type minimum of 30 words per minute
Knowledge of medical terminology and CPT-4/ICD-10 coding required

Functional Accountabilities
Registration and Scheduling Services
  • Ensure accuracy of scheduling patients using the applicable scheduling system for the department: schedule routine and add-on exams; schedule complex radiological exams prior to the patient's arrival.
  • Review patient Surgical Plan of Care from Physician when scheduled in conjunction with diagnostic exams. Schedule complex ancillary and non-complex surgical procedures using scheduling system; while coordinating with both the physician's and parent's schedules
  • Complete computer aided, on-line registration screen with parent/guardian via telephone or in person in professional & courteous manner.
  • Collect accurate demographic and insurance information. Update systems as needed in accordance with department standards for registration accuracy
  • Counsel parents or refers parent to Financial Information Center (FIC) for establishing payment schedule or method of payment.
  • Responsible for information distributed via email; check work email a minimum of 3 times daily and respond to inquiries within 24 hours (or next business day)
Verifying Insurance/ Authorization
  • Verify insurance eligibility using applicable eligibility system. Ensure that managed care carve outs (ie: lab and radiology) are adhered to. Notify insurance companies or review agency as required by hospital contract and document notification as defined by policy.
  • Obtain authorizations as needed with clinical information; document authorization in the patient account accordingly.
  • Notify parents of the need for completed insurance referral form or pre-authorization prior to scheduled/unscheduled appointment.
Performance Improvement, Mentoring, and Training
  • Monitor and correct registration errors on a daily basis ensuring quality standards.
  • Provide input to manager about registration errors for ongoing training purposes.
  • Work with manager to reduce registration and authorization denials.
  • Provide expertise to peers throughout the institution: collaborate with peers to ensure exams are scheduled appropriately.
Productivity and Quality
  • Complete calls in an accurate and timely manner; transfer calls to appropriate areas as needed; notify manager/supervisor of difficult calls (clarification re insurance, problem callers, etc.); seek appropriate resources to solve problems effectively.
  • Respond to patient portal work lists (i.e. appointment requests, fax queues, email requests, etc.).
  • Maintain high ACD Quality departmental standards including but not limited to scripting, abandonment rate, call to answer, availability.
  • Anticipate customer service needs to "prevent fires".
Program Knowledge
  • Stay current on insurance company updates and changes provided by the Financial Clearance Center.
  • Understand Call Center functions, staffing and processing; complete all required fields of information in the appropriate system.
  • Learn and maintain working knowledge of current and new systems.
Organizational Accountabilities
Organizational Accountabilities (Staff)
Organizational Commitment/Identification
  • Anticipate and responds to customer needs; follows up until needs are met
Teamwork/Communication
  • Demonstrate collaborative and respectful behavior
  • Partner with all team members to achieve goals
  • Receptive to others' ideas and opinions
Performance Improvement/Problem-solving
  • Contribute to a positive work environment
  • Demonstrate flexibility and willingness to change
  • Identify opportunities to improve clinical and administrative processes
  • Make appropriate decisions, using sound judgment
Cost Management/Financial Responsibility
  • Use resources efficiently
  • Search for less costly ways of doing things
Safety
  • Speak up when team members appear to exhibit unsafe behavior or performance
  • Continuously validate and verify information needed for decision making or documentation
  • Stop in the face of uncertainty and takes time to resolve the situation
  • Demonstrate accurate, clear and timely verbal and written communication
  • Actively promote safety for patients, families, visitors and co-workers
  • Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance