Member Access Representative

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that's served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It's our passion.

Primary Purpose

The Member Access Representative is at the forefront of creating exceptional patient experiences and health outcomes that lead to happier, healthier, and more engaged members and their eligible dependents. As a key contributor of the clinic team, the Member Access Representative is accountable for providing first contact resolution to all care access needs, such as appointment scheduling, referrals, clinical message requests, health information documentation, financial assistance, and customer service.

Education

* Must have completed training through an accredited Medical Assistant training program or obtain training within 18 months of hire date.

* Must have a High School diploma or GED.

Experience

* Must have three (3) years of medical office, business office, call center or customer service

experience.

* Patient registration and appointment scheduling experience preferred.

Certification/Registration/Licensure

* Medical Terminology Course Certificate and/or Medical Assistant Certification preferred.

Skills or Special Abilities

* Must be able to work collaboratively with colleagues to deliver patient/customer services that

exceeds patient expectations as evidenced by patient satisfaction scores.

* Must be able to communicate effectively with all hospital personnel, patients and visitors.

* Must be detail oriented and have sharp analytical skills to resolve access issues as related to

multiple groups including third-party payors, physicians, patients and the system.

* Must be able to demonstrate competency required as applicable to specialty area.

* Must have familiarity with diagnostic ICD-10 CM coding and HCPCS-CPT4 procedure codes.

* Must have working knowledge of medical terminology.

* Must be able to demonstrate basic clerical skills and working knowledge of standard office

equipment.

* Must be able to solve problems within the guidelines of established policies and procedures.

* Must demonstrate a positive demeanor, good verbal and written communication skills, and a

professional appearance and approach.

* Must be able to adjust to multiple demands, shifting priorities and rapid change.

* Bilingual skills preferred.

Responsibilities

1. Assists patients with complex scheduling needs to ensure appointments are scheduled as

expeditiously as possible. Ensures referral is approved prior to scheduling, if referral required.

Reviews specialty clinic referral note for scheduling instructions. Ensures appointment notes are

clear and concise. Demonstrates knowledge of clinic scheduling rules and pre-clinical

requirements for each clinical area. Contacts medical provider or clinical area, as needed, for

clarification.

2. Places patient on the recall or wait list when appointments are not available. Communicates

patient's options for health care while on the recall/wait list. Works recall or wait lists contacting

patients for appointment scheduling, as assigned.

3. Gathers, verifies and documents data elements including patient demographics and funding

information to ensure that patient information is complete and accurate prior to the date of service. Performs a thorough search prior to creating a new medical record number to prevent duplicate

medical record numbers. Updates demographics as needed.

4. Communicates to the patient the patient's financial responsibility including co-payments and fees for each clinical area based on financial classification and whether an authorized referral is

required for service. Reviews the patient account to determine whether patient is funded or not.

Completes benefit verification function prior to scheduling as required by financial classification.

Verifies assigned Primary Care Physician per managed care plan. Educates patient on financial

assistance process. Refers non-funded patients to financial counseling.

5. Enters referrals on-line, as assigned, with 3% or less error rate. Assists other Member Access

Representatives with more difficult referral entries. Obtains clinical assistance as needed for

issues identified on referrals. Pends referrals based on financial classification to appropriate staff for clinical and financial clearance as required. Obtains clinical and financial data for outside

provider referrals to Parkland and communicates information to appropriate staff for disposition.

Manages clinical denials of referrals. Ensures referral documentation is clear and concise.

6. Identifies need for a telephone encounter during patient call. Reviews past/current encounters to prevent duplication. Completes addendums as needed. Documents necessary information

(signs/symptoms, medication name, contact information, etc.). Routes telephone encounters

appropriately.

7. Maintains a positive working relationship and effective communication with patients, health care providers, clinic personnel, management and other employees to ensure interactions are

professional in manner and promotes a positive image for Parkland.

8. Supports all clerical, health information documentation, and other business operations tasks as assigned by management.

9. Works scheduling and denial work queues between calls and as assigned contacting patients for scheduling and notifying referring provider for denials. Enters data into Access database as

required. Completes special projects as assigned by management.

10. Serves as a resource for training staff in the area. May serve in a leadership role on department

committees/projects.

11. Telehealth - Provide education to patients/caregivers on how to properly connect for virtual

services

12. Telehealth - Directly engage patient to assess telehealth experience and feedback

Job Accountabilities

1. Identifies ways to improve work processes and improve customer satisfaction. Makes

recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland.

2. Stays abreast of the latest developments, advancements, and trends in the field by attending

seminars/workshops, reading professional journals, actively participating in professional

organizations, and/or maintaining certification or licensure. Integrates knowledge gained into

current work practices.

3. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws,

accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.As part of our commitment to our patients and employees' wellness, Parkland Health is a tobacco and smoke-free campus.