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Patient Access Representative
2 months ago
The Patient Access Representative is responsible for collecting patient information, obtaining current insurance information, and verifying insurance coverage. This position creates and maintains accurate electronic health records and gathers consent, privacy, and authorization forms. The Patient Access Representative is responsible for scheduling, canceling, and rescheduling patient appointments for their respective clinic/department. The person in this position should demonstrate excellent customer service skills and help to resolve patient issues in a prompt, professional manner.
Key Responsibilities- Greet and assist all patients and visitors in a courteous and friendly manner in person, or via phone; assist them with general problems or complaints; make patient appointment reminder phone calls; refer calls or take accurate and complete messages.
- Determine the eligibility of patients seeking healthcare, who have not been previously treated within Cherokee Nation Health System, by obtaining a Certification of Degree of Indian Blood (CBID) card or other documentary proof of tribal membership in a federally recognized tribe.
- Assist patients in completing new or updated forms and gather patient signatures as required. This includes inpatient, outpatient, emergency and after-hours patients.
- Interview all new and existing patients to obtain pertinent registration information necessary to ensure proper healthcare standards. For pre-registration purposes, this would be done via phone.
- Verify patient billing information through automated processes, registration interfaces, patient contact and payer contact by phone as necessary. For pre-registration purposes, this would be done via phone.
- Scan all third party health cards and explain to patients why it is necessary for the facility to bill for services rendered.
- Maintain current knowledge and implement the Privacy Act, Health Insurance Portability and Accountability Act (HIPPA), and other applicable patient confidentiality rules and regulations.
- Enter Medicare, Medicaid, and private/commercial insurance (i.e. medical, pharmacy, dental, behavioral health, vision, etc.) into electronic records system.
- Review notes and communicate with the Patient Benefits Advocate/Patient Benefits Coordinator to exchange billing information and to ensure coordination of patient eligibility and benefits.
- Schedule, cancel, and reschedule patient appointments; make other appropriate designations and their scheduling queues to ensure all patient appointments are scheduled in a timely manner.
- Work daily with the automated appointment reminder application and reports.
- Ensure patient appointment slots have the appropriate time allotment, as defined by medical staff.
- Send out letters of correspondence from the clinic/department to patients.
- Maintain acceptable production and quality assurance standards.
- Serve as the front line of contact for the patients.
- Must operate computerized programs and databases in order to enter, modify, and retrieve sensitive information/data into or from the electronic health record application(s); i.e. scheduling systems, registration systems, and reporting systems.
- Monitor scheduling queues/wait lists to ensure that patient referrals are handled appropriately and timely.
- Assess patient status, obtain authorization of hospitalization and outpatient services prior to the services being rendered.
- Provide retro reviews and appeals to insurance companies as needed.
- Answer calls from insurance companies, physician offices, hospitals, and patients using exemplary customer service.
- Document pre-certification numbers as needed in the electronic health records applications and designated areas so that the information is easily accessible to other departments.
- Coordinate and work with providers, case management, insurance carriers, patient access billing, and the patient in securing authorization(s)/payment(s) or service(s) provided.
- Expedites referrals that are emergency-based on medical personnel's recommendations.
- Communicate effectively and politely with patients when rescheduling appointments.
- Complete daily log forms for productivity calculations.
- Use strong interpersonal/human relationship skills in order to provide exceptional customer service with patients and co-workers, Internal and external.
- Direct patient inquiries to the appropriate personnel (i.e. medical personnel).
- Verify all patient information for accuracy and completeness (demographic, insurance, emergency contacts, and eligibility).
- File and retrieve applications and records in accordance with established procedures and filing systems; researches lost or missing applications or records in accordance with established procedures.
- Tabulate data as required; assembles and repairs records and files as necessary.
- Order and issue supplies as appropriate.
- Operate copier, fax machines, or other office equipment.
- Assist and train other/new team members.
- Follow defined call-in procedures as established by the supervisor.
- EDUCATIONAL REQUIREMENT: High School diploma or general education degree (GED); or at least six (6) months of specialized training, education, or experience.
- EXPERIENCE REQUIREMENT: At least six months experience in a related field and experience with Medicaid, Medicare, and third-party billing and guidelines preferred.
- COMPUTER SKILLS: An individual should have knowledge of Database software.
- CERTIFICATES, LICENSES, REGISTRATIONS: None.
- OTHER SKILLS AND ABILITIES: None.
- OTHER QUALIFICATIONS: Employee must not and will not be under sanction by the United States Department of Health and Human Services Office of the Inspector General (OIG) or by the General Services Administration (GSA) or listed on the OIG's Cumulative Sanction Report, or the GSA's List of Excluded Providers, or listed on the OIG's List of Excluded Individuals/Entities (LEIE).
