Patient Access Representative

The Patient Access Representative ensures timely and accurate patient registration, acting as a liaison among patients/families, payers, Medical Records, Patient Financial Services, and other healthcare team members. Using a unique medical record number, the role facilitates patient tracking and billing by obtaining and verifying complete demographic information, financially securing accounts, and collecting out‑of‑pocket responsibility from guarantors to maximize hospital reimbursement. The position maintains compliance with EMTALA, The Joint Commission, and all applicable hospital and government regulations, and identifies patients who may qualify for government resources or the hospital’s charity program, referring them to a financial counselor.

Qualifications

• High school diploma required.
• Six months experience as an admissions representative/counselor performing all aspects of the registration process preferred.
• Associate or bachelor’s degree may be substituted for the experience.

Responsibilities

• Obtain, verify, and enter complete and accurate demographic information on all accounts to facilitate smooth processing through the revenue cycle.
• Thoroughly search the patient accounting system for an existing medical record on each visit and use appropriate search techniques to prevent duplicate records in the master patient index.
• Enter demographic data accurately, including correct spelling of patient name, date of birth, gender, address, phone number, guarantor information, and follow hospital protocol for middle names and suffixes.
• Monitor and work assigned DARs and work queues daily to ensure all account elements are secured for billing.
• Financially secure all patient accounts to maximize hospital reimbursement while providing customer‑service‑oriented support.
• Verify insurance benefits for all plans, confirm the correct payer and plan are entered into EPIC, and enter patient estimates in estimating software when required.
• Obtain insurance referrals as required, documenting referral numbers for accurate billing.
• Determine whether clinical authorization is required and involve the Authorization Specialist when needed.
• Provide estimates of patient liability to the patient/guarantor prior to the visit as part of financially securing the account.
• Engage the financial counseling department for self‑pay accounts that need assistance with funding.
• Pre‑register patients 2–10 working days in advance of appointments/admissions to ensure the highest possible customer service.
• Register unscheduled patients promptly, obtaining insurance benefits and referrals/authorizations before services are provided or before discharge.
• Obtain clinical and financial authorizations as required by contract for services.
• For patients admitted as inpatients from outpatient areas, verify inpatient benefits, notify bed control, and initiate the pre‑certification process.
• Identify non‑resource patients who may be eligible for government resources or the hospital’s charity program and refer them to a financial counselor.
• Maintain compliance with EMTALA, The Joint Commission, and all other relevant hospital and government regulations applicable to the admissions setting.

About Us

Since 1954, Texas Children’s has been a leader in patient care, education, and research, accelerating health care for children and women worldwide. Recognized consistently as the best children’s hospital in Texas and among the nation’s top by U.S. News & World Report, we have earned accolades such as Houston Business Journal’s “Best Places to Work” for ten consecutive years. Our comprehensive health‑care network includes the primary hospital in the Texas Medical Center, the Jan and Dan Duncan Neurological Research Institute, the Feigin Tower for pediatric research, Texas Children’s Pavilion for Women, multiple regional campuses, Texas Children’s Health Plan (the nation’s first HMO focused on children), Texas Children’s Pediatrics, urgent‑care clinics, and a global health program. We are affiliated with Baylor College of Medicine and employ over 15,000 dedicated team members.