Patient Access Representative, Pediatric Orthopedic Clinic

About the role

Responsible for accurately registering patients in EMR, validating patient information, verifying insurance coverage, collecting required payments, and ensuring a best-in-class patient experience. Relies on established guidelines and works under close supervision.

Responsibilities

• Provide courteous and professional customer service, advising patients on collection and billing procedures, anticipated charges, and payment responsibilities (target: fewer than 5 complaints per year).
• Greet patients and families warmly, addressing questions and concerns promptly to ensure no customer complaints.
• Inform patients of their rights and Advance Directives upon request.
• Accurately obtain, edit, and maintain patient and insurance information in the clinic’s computer system.
• Register patients efficiently in Epic, monitor patient flow, and use initiative to optimize the patient experience.
• Review patient accounts to determine financial responsibility, arrange payment plans, and collect outstanding balances.
• Assist patients with access to government and community resources to improve healthcare access.
• Collaborate with physicians, nurse practitioners, and nursing staff to complete referrals in compliance with payor requirements.
• Facilitate patient access to information, including MyChart.
• Update patient records and enter charges accurately.
• Process documentation related to patient referrals and schedule/reschedule appointments to maintain smooth clinic flow.
• Perform clerical duties, including answering phones, retrieving medical records, data entry, and typing memorandums.
• File patient charts and information accurately for easy retrieval.
• Research and resolve claim edits and denials within 2 days of notification.
• Ensure billing information, including physician charges, is accurate and discrepancies are resolved within 2 days.
• Key charges, process batches daily, and prepare bank/deposit summaries after balancing payments.
• Review diagnosis and procedure codes for accuracy and enter data into the system at the point of service.
• Verify and collect patient payments for services rendered 100% of the time.
• Verify account balances, collect outstanding balances, and reconcile the daily cash fund.
• Maintain knowledge of health plans, including co-pays, deductibles, and co-insurance.
• Manage cash securely and in accordance with established policies to ensure accurate crediting to patient accounts.
• Meet site collection goals.
• Act as a backup for other clinic staff as needed.
• Support clinic, hospital, and health system initiatives to improve day-to-day operations.
• Provide training and orientation for other team members when assigned.
• Perform other duties as assigned.

Requirements

• 6 months of experience in a customer service or front desk role, or graduation from a front office/medical office program.
• A Bachelor’s degree may substitute for experience.
• High School Diploma or equivalent.

Skills

• Professional demeanor and excellent customer service skills.
• Ability to multi-task and think critically.
• Demonstrated computer literacy.
• Ability to learn and demonstrate proficiency in Epic during the introductory period.