What are the responsibilities and job description for the Patient Access Representative - Adult Outpatient Pavilion position at VCU Health?
The Patient Access Representative delivers high-quality customer service to patients of all ages, their families, visitors, medical staff, clinicians and co-workers, ensuring all interactions are courteous, timely and respectful.
The Patient Access Representative handles all business functions in an assigned clinical department area to include reception, scheduling, and registering patients for appointments and/or procedures. This position also secures the appropriate patient information; ensures that registration data is correct and accurate; validates insurance eligibility, ensuring accurate data entry; collects co-pays, and supports financial counseling and financial clearance, as necessary.
Essential Job Statements
Greet Patients/Answer Telephone
Provides exceptional customer service by welcoming patients and visitors in a friendly, professional, and respectful manner. Ensures individuals are respected and informed, communicating clearly and effectively, and utilizing appropriate language resources as needed. Assists with traffic flow in and out of the clinic as needed. Addresses patient needs promptly, and maintains a courteous, professional tone at all times.
Co-payment Collection & Registration Data
Collects all patient co-payments and deposits accurately per payer, following department guidelines. Verifies and updates registration data, including demographic and insurance information. Copies and records insurance information per department standards. Follows department policies for cash handling, including cash reconciliation and deposit preparation.
Referral Management
Verifies insurance coverage and understands requirements for HMO, managed care, government and private plans. Secures required referrals/authorizations and links them correctly in the referral module. Obtains needed referrals and authorizations before scheduled procedures, tests, injections and surgeries. Communicates plan-specific referral/authorization requirements to patients and providers. Provides pre-payment guidance for self-pay patients and offers financial assistance. Prepares cost estimates, explains payment expectations and documents all interactions in the patient account.
Appointment Scheduling, Lab & Test Order Entry
Correctly schedules clinic appointments through the medical records software/communication platform. Transcribes physician orders accurately and completely (i.e. lab test, ancillary test) and records them in the appropriate system(s) according to the physician’s instructions and VCUHS policy. Coordinates the collection of pre-operative testing and paperwork, where appropriate.
Patient Record/Verify Registration Data
Maintains proficiency in all aspects of patient medical record keeping in an organized manner. Assists in preparation of the chart before the patient visits. If applicable, assists in breaking down the chart at the completion of the patient's visit. Ensures that all patients arrived in the appointment scheduling system before the end of the appointment day. Where appropriate, appointments are documented as “no-shows” or cancellations before the end of the appointment day. Obtains signatures and completes the required forms including those from managed care and other insurance plans.
E-Documents Management & Scanning
Obtains and scans all appropriate patient medical documentation.
Miscellaneous Responsibilities
Notifies supervisor of issues involving violation of VCUHS policies or procedures.
Performs other duties as assigned and/or participates in special projects to support the mission of VCUHS and department.
Patient Population: N/A
Employment Qualifications
Education Required: High School Diploma or equivalent
Education Preferred: Associates or Bachelor’s Degree in Accounting, Finance, Business Administration, Healthcare Administration or closely related field from an accredited program.
Licensing/ Certification
Licensure Required: N/A
Licensure Preferred: N/A
Certification Required: N/A
Certification Preferred: N/A
Minimum Qualifications
Years and Type of Required Experience:
Demonstrated experience using computers, Microsoft Office applications, and web-based platforms
Experience Preferred: Work experience with medical insurance, HMO, managed care, electronic medical billing/order entry/registration systems, and appointment scheduling.
Previous work experience in a healthcare setting, and knowledge of medical terminology.
Other Knowledge, Skills and Abilities Required: Able to perform daily activities with minimal supervision: being self-directed in the accomplishment of routine activities.
Other Knowledge, Skills and Abilities Preferred: Depending on assignment, may be required to work off-shifts and/or weekend and holidays.
Working Conditions: Periods of high stress and fluctuating workloads may occur. General office environment. May have periods of constant interruptions. Prolonged periods of working alone.
Physical Requirements
Physical Demands: Lifting/ Carrying (0-50 lbs.), Push/ Pull (0-50 lbs.), Stoop, Kneel, Squat, Crawling, Climbing, Balance, Bending
Work Position: Sitting, Walking, Standing
Additional Physical Requirements/ Hazards
Physical Requirements: Manual dexterity (eye/hand coordination), Perform shift work, Hear alarms/telephone/tape recorder, Repetitive arm/hand movements
Hazards: N/A
Mental/Sensory – Emotional
Mental/Sensory: Strong Recall, Reasoning, Problem Solving, Hearing, Speak Clearly, Reading, Logical Thinking
Emotional : Fast pace environment, Able to Handle Multiple Priorities, Frequent and Intense Customer Interactions, Able to Adapt to Frequent Change
EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.
The Patient Access Representative handles all business functions in an assigned clinical department area to include reception, scheduling, and registering patients for appointments and/or procedures. This position also secures the appropriate patient information; ensures that registration data is correct and accurate; validates insurance eligibility, ensuring accurate data entry; collects co-pays, and supports financial counseling and financial clearance, as necessary.
Essential Job Statements
Greet Patients/Answer Telephone
Provides exceptional customer service by welcoming patients and visitors in a friendly, professional, and respectful manner. Ensures individuals are respected and informed, communicating clearly and effectively, and utilizing appropriate language resources as needed. Assists with traffic flow in and out of the clinic as needed. Addresses patient needs promptly, and maintains a courteous, professional tone at all times.
Co-payment Collection & Registration Data
Collects all patient co-payments and deposits accurately per payer, following department guidelines. Verifies and updates registration data, including demographic and insurance information. Copies and records insurance information per department standards. Follows department policies for cash handling, including cash reconciliation and deposit preparation.
Referral Management
Verifies insurance coverage and understands requirements for HMO, managed care, government and private plans. Secures required referrals/authorizations and links them correctly in the referral module. Obtains needed referrals and authorizations before scheduled procedures, tests, injections and surgeries. Communicates plan-specific referral/authorization requirements to patients and providers. Provides pre-payment guidance for self-pay patients and offers financial assistance. Prepares cost estimates, explains payment expectations and documents all interactions in the patient account.
Appointment Scheduling, Lab & Test Order Entry
Correctly schedules clinic appointments through the medical records software/communication platform. Transcribes physician orders accurately and completely (i.e. lab test, ancillary test) and records them in the appropriate system(s) according to the physician’s instructions and VCUHS policy. Coordinates the collection of pre-operative testing and paperwork, where appropriate.
Patient Record/Verify Registration Data
Maintains proficiency in all aspects of patient medical record keeping in an organized manner. Assists in preparation of the chart before the patient visits. If applicable, assists in breaking down the chart at the completion of the patient's visit. Ensures that all patients arrived in the appointment scheduling system before the end of the appointment day. Where appropriate, appointments are documented as “no-shows” or cancellations before the end of the appointment day. Obtains signatures and completes the required forms including those from managed care and other insurance plans.
E-Documents Management & Scanning
Obtains and scans all appropriate patient medical documentation.
Miscellaneous Responsibilities
Notifies supervisor of issues involving violation of VCUHS policies or procedures.
Performs other duties as assigned and/or participates in special projects to support the mission of VCUHS and department.
Patient Population: N/A
Employment Qualifications
Education Required: High School Diploma or equivalent
Education Preferred: Associates or Bachelor’s Degree in Accounting, Finance, Business Administration, Healthcare Administration or closely related field from an accredited program.
Licensing/ Certification
Licensure Required: N/A
Licensure Preferred: N/A
Certification Required: N/A
Certification Preferred: N/A
Minimum Qualifications
Years and Type of Required Experience:
Demonstrated experience using computers, Microsoft Office applications, and web-based platforms
Experience Preferred: Work experience with medical insurance, HMO, managed care, electronic medical billing/order entry/registration systems, and appointment scheduling.
Previous work experience in a healthcare setting, and knowledge of medical terminology.
Other Knowledge, Skills and Abilities Required: Able to perform daily activities with minimal supervision: being self-directed in the accomplishment of routine activities.
Other Knowledge, Skills and Abilities Preferred: Depending on assignment, may be required to work off-shifts and/or weekend and holidays.
Working Conditions: Periods of high stress and fluctuating workloads may occur. General office environment. May have periods of constant interruptions. Prolonged periods of working alone.
Physical Requirements
Physical Demands: Lifting/ Carrying (0-50 lbs.), Push/ Pull (0-50 lbs.), Stoop, Kneel, Squat, Crawling, Climbing, Balance, Bending
Work Position: Sitting, Walking, Standing
Additional Physical Requirements/ Hazards
Physical Requirements: Manual dexterity (eye/hand coordination), Perform shift work, Hear alarms/telephone/tape recorder, Repetitive arm/hand movements
Hazards: N/A
Mental/Sensory – Emotional
Mental/Sensory: Strong Recall, Reasoning, Problem Solving, Hearing, Speak Clearly, Reading, Logical Thinking
Emotional : Fast pace environment, Able to Handle Multiple Priorities, Frequent and Intense Customer Interactions, Able to Adapt to Frequent Change
EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.