Purpose and Scope :

Patient Access Service Center Representative is responsible for scheduling and registering patents for all modalities including but not limited to admissions, surgical procedures and diagnostic testing throughout Estes Park Health utilizing a computerized scheduling EMR System and multiple software applications.

The employee will have interactions with all levels of staff and management, physicians, patients and families to obtain information to properly schedule and register services.

The employee will use judgement and clinical knowledge to adjust schedules and accommodate special requests from internal and external customers.

Hiring Range and Shift :

$19.33 to $26.29, depending on experience.

Mon-Fri, 8hr shifts

• Responsible for accurately Scheduling patient appointments utilizing Electronic Medical Record (EMR) Epic System Work Queues, Referrals, Phone or Fax
• Obtains Insurance Authorizations through Payer websites and / or phone call for all Outpatient and Inpatient procedures requiring a Pre-Authorization.

Assure regulatory and compliance requirements following local payor coverage determinations by running Medical Necessity Checks when needed and completes necessary ABN.

Capturing and documenting all pertinent patient demographics (i.e., subscriber / guarantor insurance information including Policy and ID number, payor address and phone number and other contact information).

Obtains required data to support hospital clinical / financial needs.

• I nsurance Verification and Benefits obtained by running Real Time Eligibility (RTE)
• Capture accurate Benefit information to be able to run a Financial Estimate for patient’s scheduled procedure.

Refers Patients for financial counseling, when applicable

• Expected to meet all Goals set by the department management to include, but not limited to : Productivity, Accuracy, Work Queue assignments, Collections and Customer Satisfaction
• Utilizes courteous and professional telephone techniques and interpersonal skills to establish / maintain rapport with patients, physicians / office personnel and various hospital personnel, while maintaining patient confidentiality.

Appropriate utilizes ACD telephone System.

• Works according to standard operating procedure during EMR or other system Downtimes
• Performs any and all related job duties as assigned; may have additional department specific duties assigned as deemed necessary by management.
• All other duties as assigned.
• Perform in accordance with all local, state and federal laws and regulatory agency standards.
• Perform in accordance with EPH vision, mission and goals

Knowledge, Skills, and Abilities :

• Proficient in the use of Computers and all MS Office Software applications
• Working knowledge of Protected Health Information
• Ability to be flexible and manage change and ability to work with speed and accuracy while completing multiple projects is required.
• Required to be able to handle complex scheduling, Authorizations and Complete Pre-Registration process.
• Must possess detailed understanding and knowledge of insurance guidelines and protocols, the components of full verification, and payer information / requirements.
• Demonstrated proficiency in the use of the current scheduling and registration EMR Software.

Education and Experience :

• 2 or 4-year college degree preferred
• Advanced degree (Associates, Bachelors, Masters) may be considered in lieu of experience
• 2-3 years of medical office experience, or 4 years of customer service experience, required.
• Thorough knowledge of third-party insurance coverage guidelines preferred
• Must successfully complete / pass EPIC training / tests
• Computer knowledge and skills required
• Ability to speak English for a business setting Bilingual a plus
• Customer focused

Last updated : 2024-05-18