Clinics Patient Access Representative

POSITION PURPOSE:  Responsible for patient registration, admissions, and associated tasks which include information collection and validation, and requisitioning of orders and services. Insurance-related tasks include: verification, collection of co-payments, and collection of associated paperwork. Performs administrative functions, scheduling, answering phones, and coordinating general requests.  

ESSENTIAL JOB FUNCTIONS:

1. Registers patients and performs all registration-related functions, including explaining and obtaining all necessary patient consents and authorizations in a complete and timely manner, and collecting financial paperwork (e.g., patient responsibility statement, etc.) and co-payment as required.

2. Communicates effectively with patient to assist in access to care by: answering telephone and other incoming communications in a timely and customer-service oriented manner; replying to inquiries, patient needs for information, and other parties clearly and in a timely manner; and, if information is not readily available, follows up with inquiries to responsible party.

3. Resolves all non-clinical questions within scope of knowledge while providing excellent customer service on the phone and/or in person.

4. Performs on-going documentation audits for medical necessity, plan of care, and other related tasks or requirements by payors, including Medicare, using a variety of computer-based systems.

5. If in a procedure-based department, routinely schedules appointments for all procedures educating each patient with pre-exam and if necessary, post-exam requirements within scope. Organizes, generates and distributes patient reminders, results, and recall letters.

6. Establishes files, maintains information, and scans medical records in a timely and organized manner.

7. Manages, directs and responds to incoming office correspondence as deemed appropriate, including mail, email, faxes, and telephone calls and forward queries to the appropriate staff.

8. Organizes, monitors, and orders front desk supply inventory to assure cost effective departmental spending.

9. Attends and provides feedback for departmental staff meetings.

10. Follow the Center for Medicare & Medicare Services (CMS) requirements for checking medical necessity communicates relevant coverage/eligibility information to the patient. Identifies patients who will need Medicare Advance Beneficiary Notices (ABNs) of non-coverage and maintains accurate records of authorizations within the EMR.

11. Completes Medicare Secondary Payer Questionnaire for Medicare beneficiaries in accordance with Centers for Medicare & Medicaid Services (CMS) standards

12. Role Models the Principals of a Just Culture and Organizational Values.

13. Ensures compliance with all applicable HIPAA, EMTLA and Joint commission requirements, providing required associated literature to patients.

14. Performs other duties as assigned on department and organizational-level.

This description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.  

MINIMUM QUALIFICATIONS:

Experience: Customer service and clerical experience.

License(s): N/A Certification(s): N/A

Computer / Typing: Must possess, or be able to obtain within 90 days, the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. Must have working knowledge of the English language, including reading, writing, and speaking English.

Education: N/A