JOB TITLE:              Patient Access Representative

DEPARTMENT:       Patient Access

REPORTS TO:         Office Manager

FLSA STATUS:       Full time – Non-Exempt

JOB SUMMARY:

The Patient Access Representative position encompasses several jobs – Front Desk Check In, Scheduling, Medical Records, and Referrals. Although you may work in one job area primarily you will be cross trained over time to be able to work in the other jobs. The main functions of this role are described in detail below.

Primary Customers Served:

T         Adult                                       T         Family/Visitors                      T         Geriatric

T         Physicians                            T         Team Members                   

T         Social Work Team                T         Community Agencies

FRONT DESK FUNCTIONS:

1. Friendly and detail orientated.
2. Duties will include but are not limited to checking patients in and out.
3. Scheduling patients for all appointment types.
4. Collecting copays/balances, current insurance cards, insurance eligibility, and filing claims, scanning all applicable paperwork into patient’s chart.
5. Answer incoming patient telephone calls to the Front Desk Hunt Group in a timely manner (Front desk calls and portal question calls)
6. Assign and/or answer unassigned Klara messages
7. Following all safety and sanitation guidelines for self, staff and patients.
8. Effective communication with all staff and patients
9. Working as a team player with fellow front desk members
10. Ability to alphabetize and put information (materials, forms, etc.) into chronological order.
11. Ability to schedule time and assignments effectively.
12. Ability to multitask effectively, dealing with phone calls, staff, patient communication.
13. Ability to communicate calmly and clearly with patients about appointments in all circumstances, including when they are ill or have an emergency.
14. Ability to analyze situations and respond appropriately.
15. Adapting to busy high-volume environments
16. Other duties as assigned
17. Equipment Operated: Range of medical records equipment and supplies, including computer hardware/software, manual files, scanners, and printers.

SCHEDULING / REFERRAL / MEDICAL RECORDS FUNCTIONS:

1. Assembles patients’ health information including patient symptoms and medical history, exam results, X-ray reports, lab tests, diagnoses, and treatment plans. Checks to ensure all forms are completed, properly identified, and signed and that all necessary information is in the EHR (Electronic Health Record).
2. Communicates as needed with physicians and other health care professionals to obtain any additional information needed.
3. Submits files/documentation to physicians and other clinicians as requested for review, quality assurance checks, and other purposes.
4. Provides charts/documents requested for use in legal actions, following patient consent and confidentiality protocols.
5. Schedules appointments for patients when they call. If medical practice offers after-hours/one-day appointments, schedules these appointments following urgent/emergency protocols, which may mean scheduling the patient with a physician or nurse practitioner other than their primary physician.
6. Uses Electronic Health Record to match physician/clinician availability with patient’s preferences in terms of date, time and patient need.
7. Ensures that all cancellations or reschedules are properly recorded.
8. Communicates as needed with physicians/clinicians and other staff about any patient concerns/issues related to scheduling.
9. Consults with Office Manager about any system problems.
10. Use customer service principles and techniques to deal with patients calmly and pleasantly.
11. Receive and process referral orders from PCP physicians.
12. Verify patient insurance eligibility and referral requirements.
13. Initiate and manage electronic and paper-based referral processes.
14. Schedule appointments with specialists and communicate appointment details to patients.
15. Obtain necessary prior authorizations and pre-certifications from insurance companies.
16. Track referral status and follow up on pending referrals.
17. Maintain accurate and up-to-date referral records in the electronic health record (EHR).
18. Provide clear and concise information to patients regarding the referral process.
19. Answer patient questions and address concerns related to referrals.
20. Assist patients with scheduling appointments and navigating the healthcare system.
21. Provide patient education regarding pre-appointment instructions and necessary documentation.
22. Communicate with patients and other clinical staff regarding referral status and appointment updates.
23. Serve as a point of contact for specialists and their staff.
24. Coordinate the exchange of medical information between primary care physicians and specialists.
25. Communicate with insurance companies to resolve referral-related issues.
26. Collaborate with other members of the healthcare team to ensure smooth patient transitions.
27. Maintain relationships with specialist offices.
28. Other duties as assigned.

Expected Hours of Work: Assigned by supervisor

Personal Protective Equipment: Must be able and willing to wear appropriate Personal Protective Equipment (PPE) required to perform the job safely.

Supervisory Responsibility:  None

Travel: Possibly to Satellite Offices for coverage

Additional Minimum Employment Requirements:

• Back Safety/Body Mechanics.
• Hep B if in clinical role

Working Conditions:

• Ability to sit for extended periods up to 8 hours working on a computer and telephone.
• Ability to lift a minimum of 25 pounds.
• General indoor conditions.
• Noise: quiet to light noise.
• Weekend and evening work may be required.
• Face to face contact with patients, answering telephones.
• Implementing OSHA Standards staff may be subjected to assist in screening patients before entry into facility.

Occupational Hazards:

• Potential for musculoskeletal injuries if proper lifting and carrying techniques are not used.

Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the position without compromising patient care.

Minimum Job Qualifications:

Education:  High School Diploma required (or equivalent) – 2 years of college desired.

License/Certifications: None required 

Language Skills:  Proficient in English (Proficient in Spanish desired)

Other Skills: 

1. Knowledge of HIPPA Privacy Rules
2. Knowledge of medical practice protocols related to scheduling appointments.
3. Knowledge of manual/computerized scheduling systems.
4. Knowledge of customer service principles, techniques and conflict resolution.
5. Knowledge in Medical Insurance
6. Account Balances -Collection of Payments
7. Excel Spreadsheets
8. Skill in dealing with masses of information in organized manner.
9. Skill in using computer and medical records software.
10. Skill in communicating effectively with physicians/clinicians about scheduling preferences.
11. Skill in manipulating several different schedules at once.
12. Skill in using Critical Thinking