What are the responsibilities and job description for the Physician Patient Access Representative I (FT) position at Citizens Medical Center?
JOB SUMMARY
The CMP Patient Access Representative is responsible for verification and data entry of patient demographics, insurance eligibility, benefit verification, referrals, and authorizations. Calculates, communicates, and collects patient financial responsibility before, during, or after services are provided, as appropriate. Sets up pre-service payment plan agreements. Works rejected or errored claims as they pertain to patient demographics, insurance eligibility, referrals, and authorizations.
Job Specific:
- Verify patient demographics and proper completion of all required patient registration forms, including accurate data entry into practice management system. (EF)
- Verify medical insurance eligibility and benefit coverage, including accurate data entry into the practice management system. (EF)
- Obtain insurance referrals and authorizations. (EF)
- Determine or calculate patient financial responsibility using all available tools (e.g., insurance patient estimators, internal calculation spreadsheets, insurance fee schedules, etc.). (EF)
- Screen clinic schedules for high balances and bad debt utilizing all available tools (e.g., Phreesia, practice management system, etc.) and attempt to collect prior to the scheduled appointment. (EF)
- Collect, process, post, and deposit patient payments, including working the prepay bucket in the practice management system.
- Set-up payment plan agreements and send out financial assistance applications, as appropriate.
- Reviews and corrects any assigned claim rejections and edits as they relate to patient demographics, insurance eligibility, benefits, referrals, and authorizations.
- Document all patient, insurance, or other communications in accordance with departmental policy. (EF)
- Organize, process, and complete the deposit protocol daily, including data entry into the general ledger.
- Sort, transport, and deliver mail and interdepartmental mail throughout the hospital campus.
- Assist the CMP clinics with patient demographics, insurance eligibility, insurance benefit verification, and data entry. (EF)
- Consult team members, supervisor, director, and other appropriate resources to resolve billing and collection questions and issues.
Hospital:
- Adheres to organization-wide and other applicable policies and procedures.
- Day-to-day performance complies with the hospital’s Service Excellence Behavioral Expectations.
- Performs within the prescribed limits of the hospital’s Ethics, Compliance and Confidentiality Program guidelines.
- Performs within professional Scope of Practice at all times.
Other Duties As Assigned:
- Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.
EDUCATIONAL REQUIREMENTS
Required:
1. Physician Patient Access Representative I: High School diploma or equivalent
2. Physician Patient Access Representative II: High School diploma or equivalent. Intermediate level knowledge of health insurance contracting and benefits terms; coordination of benefit rules, secondary payor, and subrogation; insurance referral and authorization requirements; ERISA, State-Governed, NSA, and other relevant patient access laws; medical anatomy and terminology.
Preferred:
1. Physician Patient Access Representative I: Knowledge of health insurance (HMO, PPO, Medicare, Medicaid, etc.); insurance benefits terms; referral and authorization requirements; medical anatomy and terminology.
2. Physician Patient Access Representative II: Associates degree in a business, legal or healthcare related field and intermediate level knowledge of patient collection laws
EXPERIENCE
Required: If hired as a Physician Patient Access Representative II: Two years of patient access experience in a physician office/practice setting within the last three years.
Preferred: Physician Patient Access Representative I: One year of medical office experience in a physician office/practice setting within the last three years.
SPECIAL SKILLS AND ABILITIES
Required:
1. Physician Patient Access Representative I: Able to work in a collaborative team environment; good verbal and written communication skills; able to organize and complete work in a timely manner; good typing and 10-key speed and accuracy; basic proficiency in Microsoft Office365 apps; basic proficiency using telephone, fax, and email.
2. Physician Patient Access Representative II: Able to read, interpret, and communicate all parts of an insurance benefits and eligibility form across all insurance payors; able to calculate patient responsibility for in-network, out of net-work, and self-pay patients, including patients with multiple insurance policies; able to work in a collaborative team environment
Preferred:
1. Physician Patient Access Representative I: Able to read, interpret, and communicate all parts of an insurance benefits and eligibility form across all insurance payors; able to calculate patient responsibility for in-network, out-of-network, and self-pay patients, including patients with multiple insurance policies.
2. Physician Patient Access Representative II: Advanced proficiency in Microsoft 365 apps
LICENSURE / CERTIFICATION REQUIREMENTS
Required: If hired as a Physician Patient Access Representative II: Certified Healthcare Access Associate (CHAA) or an approved, equivalent certification.
COMPANY PROFILE
Citizens Medical Center is a not-for-profit, community hospital known for compassionate patient care, clinical expertise, and bringing advanced medical services to the South Texas region since 1956. Today, Citizens is a 317-bed acute care hospital with over 1,200 employees. Voted “Best of the Best” hospital in Victoria for 14 consecutive years, Citizens Medical Center is a level III Trauma Center, with a newly renovated 24/7 Emergency Department that includes an onsite medical helicopter. Citizens has a comprehensive Community Cancer Program that includes two linear accelerators and HDR brachytherapy. Citizens is recognized for its outstanding cardiology program which includes a nationally accredited Chest Pain Center and is a Primary Stroke Center. Citizens also includes a comprehensive, accredited Bariatric Surgery program, Birth Center with labor and delivery, an imaging and surgery center, sleep study center, state-of-the-art rehabilitation and fitness center, urology center and daVinci robotics minimally invasive surgery options, a home health agency, and has a long history of providing continuing education for healthcare providers and the community.
Citizens Medical Center is looking for employees who actively demonstrate service excellence by exemplifying our iCare values. If you are someone who displays respect and enthusiasm for patients, visitors, and coworkers while consistently upholding the hospital’s commitment to providing outstanding outcomes, service excellence, and fiscal responsibility, then you could be a good fit for the CMC team!
BENEFIT OFFERINGS
Health
- Medical, Dental, Vision
- STD, LTD Disability
- Supplemental Life, AD&D
- Flexible Spending (FSA)
- Employer paid life insurance and short term disability
Retirement/Investment
- Defined Benefit Pension Plan
- 457(b) Deferred Compensation
Well-Being Benefits
- Paid Time Off
- Sick leave, Bereavement leave, Jury Duty/Witness Service
- Tuition Reimbursement
- Hospital-paid & administered annual immunizations
- HealthPlex (gym) membership discount
- YMCA partnership discount for childcare
- Employee Assistance Programs