Patient Access Center Representative

About the role

This position is responsible for assuring that patients in need of scheduling appointments are scheduled to receive services in their assigned location and are financially cleared prior to their scheduled appointment through accurate and timely scheduling, registration, and verification of eligibility and benefits. The Patient Access Center Representative assists management with ongoing observations and notifications of opportunities while providing innovative suggestions for process improvement. Additional responsibilities include providing excellent customer service when communicating with patients who receive services at our facilities and providing notification to patients, physicians, hospital/clinical staff and management of issues that may result in potential service delays or reimbursement denials.

Responsibilities

• Assist management with auditing/quality review to ensure accurate and appropriate scheduling and registration.
• Provide excellent customer service when communicating with patients who receive services at our facilities.
• Provide notification to patients, physicians, hospital/clinical staff and management of issues that may result in potential service delays or reimbursement denials.
• Utilize computerized scheduling/registration systems, verification systems, and online applications while balancing departmental resources.
• Obtain required data in order to support departmental and hospital clinical/financial needs.
• Triage calls for the System Patient Access Center as appropriate to other areas as received on a daily basis while working under the guidelines and scripts as set forth by management.
• Provide patients with information needed to prepare for appointment per Center/Service protocol.
• Encourage patients to enroll on the Patient Portal and provide PIN numbers, complying with HIPAA regulations.
• Follow established protocols directly as indicated by management and physicians on applicable platforms on an as needed basis and consistently utilize multiple software applications to schedule appointments.
• Keep open channels of communication with all parties involved, including physician, patient, and service areas, regarding action taken and resolution.
• Promote a friendly and professional customer service environment.
• Utilize courteous and professional telephone techniques and interpersonal skills to establish and maintain rapport with patients, physicians/office personnel and various hospital personnel, while maintaining patient confidentiality.
• Appropriately utilize telephone system and department scripting and appointment scheduling policy when scheduling appointments and ensure ICARE values are met while working within the scripting provided.
• Assist with new referral from E-fax and emails along with specific doctors’ offices calling directly to schedule emergency patients’ same day or within 24 hours as needed.
• Coordinate the workflow to assist patients with appointment scheduling and/or requests for services: collect and compile data/information from patients such as insurance documentation and patient identification information to help facilitate an appointment.
• Screen and assess patient calls received and assure that the patients are scheduled for services as requested by referring physician or upon patient’s request.
• Schedule patient appointments and efficiently complete registration.
• Answer incoming calls from patients and act as liaison between the patient and the physician or clinical staff.
• Handle calls from physician offices or hospital departments, always making sure to maintain a good relationship and obtain all necessary documents needed to support the scheduling process.
• Help facilitate, coordinate, and resolve issues with patients by exhibiting and exercising exceptional telephone, verbal, written, exemplary critical thinking and interpersonal communication skills.
• Adhere to scheduling processes and workflows as defined in the electronic medical record platform while maintaining privacy and complying with HIPAA guidelines.
• Maintain standard of productivity set by department policy and procedures and meet scheduling goals set by the department (e.g., abandonment rate, productivity per hour, etc.).
• Utilize resources to perform verification of patient insurance and ensure verification and eligibility procedures are followed prior to patient visit.
• Work in partnership with the revenue cycle team and other departments to ensure the correct information and registration is complete and accurate prior to the patient visiting Houston Methodist for services.
• Obtain and enter accurate scheduling and registration data, including but not limited to patient demographics, insurance, guarantor, and clinical information on the information system in order to initiate financial clearance activities (benefit eligibility and verification, pre-certification notification and payment review).
• Document patient’s accounts with information related to any potential issue(s) that could result in service delays or cancellations due to the lack of financial clearance.
• Work directly with physicians, clinic staff, hospital departments and patients to ensure best practices within department.
• Work with manager to improve areas requiring concern as indicated, embrace change, and strive for excellence in the workplace.
• Apply new learning and share knowledge with others.

Requirements

• High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)
• Three years of experience in healthcare setting/call center or customer service operations or successful completion of one-year Houston Methodist Call Center Apprenticeship in lieu of years of experience
• Healthcare setting knowledge and experience with a strong understanding of medical terminology preferred

Licenses and certifications

• Required

Skills and abilities

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through ongoing skills, competency assessments, and performance evaluations
• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
• Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
• Excellent communication and interpersonal skills via telephone and in person
• Demonstrated proficiency in medical terminology to include diagnoses, operative procedures, and CPT codes
• Knowledge of medical terminology and applicability
• Excellent spelling/grammar skills
• Working knowledge of PC environment utilizing Windows and word processing and basic Excel knowledge; must be able to enter data via keyboard throughout the work schedule
• Capable of working and navigating several applications and websites related to registration simultaneously
• Managed care knowledge with the ability to differentiate between insurance plans such as PPO, POS, HMO, etc.

Work attire

• Uniform: No
• Scrubs: No
• Business professional: Yes
• Other (department approved): No

On-call

Note that employees may be required to be on-call during emergencies (e.g., disaster, severe weather events, etc.) regardless of selection below.

• On Call: No

Travel

• May require travel within the Houston Metropolitan area: Yes
• May require travel outside Houston Metropolitan area: No