Patient Access Representative

Overview

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.

Qualifications

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).

Knowledge of interview techniques and billing office requirements. Knowledge of medical terminology due to the technical nature of the health care process as it relates to access to care, policies and procedures that affect patient flow, patient care, and the revenue process.

PHYSICAL DEMANDS

While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle or feel; and talk or hear. The employee must occasionally be able to lift and/or move up to 10 pounds.

WORK ENVIRONMENT

The noise level in the work environment is normally moderate.

Greets and assists all patients and visitors in a courteous and friendly manner in person, or via phone; assists them with general problems or complaints; makes patient appointment reminder phone calls; refers calls or takes accurate and complete messages. Determines 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. Assists patients in completing new or updated forms and gathers patient signatures as required. This includes inpatient, outpatient, emergency and after-hours patients. Interviews 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. Verifies 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. Scans all third party health cards and explains to patients why it is necessary for the facility to bill for services rendered. Maintains current knowledge and implements the Privacy Act, Health Insurance Portability and Accountability Act (HIPPA), and other applicable patient confidentiality rules and regulations. Enters Medicare, Medicaid, and private/commercial insurance (i.e. medical, pharmacy, dental, behavioral health, vision, etc.) into electronic records system. Reviews notes and communicates with the Patient Benefits Advocate/Patient Benefits Coordinator to exchange billing information and to ensure coordination of patient eligibility and benefits. Schedules, cancels, and reschedules patient appointments; makes other appropriate designations and their scheduling queues to ensure all patient appointments are scheduled in a timely manner. Works daily with the automated appointment reminder application and reports. Ensures patient appointment slots have the appropriate time allotment, as defined by medical staff. Sends out letters of correspondence from the clinic/department to patients. Maintains acceptable production and quality assurance standards. Serves 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. Monitors scheduling queues/wait lists to ensure that patient referrals are handled appropriately and timely. Assesses patient status, obtains authorization of hospitalization and outpatient services prior to the services being rendered. Provides retro reviews and appeals to insurance companies as needed. Answers calls from insurance companies, physician offices, hospitals, and patients using exemplary customer service. Documents pre-certification numbers as needed in the electronic health records applications and designated areas so that the information is easily accessible to other departments. Coordinates and works 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. Communicates effectively and politely with patients when rescheduling appointments. Completes daily log forms for productivity calculations. Uses strong interpersonal/human relationship skills in order to provide exceptional customer service with patients and co-workers, Internal and external. Directs patient inquiries to the appropriate personnel (i.e. medical personnel). Verifies all patient information for accuracy and completeness (demographic, insurance, emergency contacts, and eligibility). Files and retrieves applications and records in accordance with established procedures and filing systems; researches lost or missing applications or records in accordance with established procedures. Tabulates data as required; assembles and repairs records and files as necessary. Orders and issues supplies as appropriate. Operates copier, fax machines, or other office equipment. Assists and trains other/new team members. Follows defined call-in procedures as established by the supervisor. Other duties may be assigned.

SUPERVISORY RESPONSIBILITIES

None

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).

Knowledge of interview techniques and billing office requirements. Knowledge of medical terminology due to the technical nature of the health care process as it relates to access to care, policies and procedures that affect patient flow, patient care, and the revenue process.

PHYSICAL DEMANDS

While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle or feel; and talk or hear. The employee must occasionally be able to lift and/or move up to 10 pounds.

WORK ENVIRONMENT

The noise level in the work environment is normally moderate.