Patient Access Representative - Physical Therapy East - Full-time - AVALA Hospital - RH485

About the Role

Under the supervision of the Director of Hand Therapy, the Patient Access Representative is responsible for obtaining accurate patient demographics and insurance information during the patient interview process, both in-person and by phone, and correcting information as needed. This role assists with obtaining prior authorizations, tracking therapy caps to avoid denials, and processing registrations, including obtaining patient signatures on required forms such as the Authorization for Treatment, Advanced Beneficiary Notice (ABN), and completing the Medicare Secondary Payer (MSP) questionnaire. The role also involves scanning documentation into Cerner, collecting co-payments and deductibles, and handling incoming phone calls.

Responsibilities

• Handle heavy phone volumes, ensuring callers are transferred to the appropriate department or person.
• Answer calls in a timely manner, identifying the department and self when answering.
• Manage all medical records for the Physical/Occupational Therapy Office.
• Prepare patient charts, ensuring all packets are accurate.
• Scan patient documents from therapists, doctors, and/or insurance into patient charts.
• Handle all scheduling and rescheduling for the Physical Therapy Office, including new and recurring appointments.
• Post payments to patient accounts.
• Fax Plan of Care to doctor offices for approval on extensions of patient visits.
• Assist with obtaining prior authorization and track therapy caps to avoid denials.
• Verify insurance and benefits coverage for all physical and occupational therapy patients prior to their appointment.
• Ensure patient demographic information is accurate and that insurance cards, consents, and other admission documents are complete and in order.
• Make copies of insurance cards and scan them into Cerner.
• Explain required forms to patients in detail (e.g., Authorization for Treatment, ABN, MSP questionnaire) and obtain required signatures.
• Contact patients to verify demographic and insurance information, and inform them of estimated balances due.
• Collect monies due at the time of service.
• Demonstrate knowledge of Cerner scheduling, accounts, and documentation features.
• Notify appropriate staff regarding any issues or concerns in a timely manner.
• Maintain cleanliness and order in the Therapy Front Office and lobby/reception waiting area, including emptying trash if necessary.
• Prepare coffee for the lobby/reception waiting room and keep coffee supplies stocked and the area clean.
• Ensure the lobby/reception waiting area is at an appropriate temperature and comfortable for patients.
• Perform other duties as assigned by the Director of Hand Therapy or COO.

Core Competencies

• Action Orientation: Targets and achieves results, overcomes obstacles, accepts responsibility, establishes standards, and follows through on actions.
• Communications: Communicates well both verbally and in writing, listens carefully, and presents ideas clearly.
• Creativity/Innovation: Generates novel ideas and improves systems to challenge the status quo.
• Critical Judgment: Defines issues and focuses on workable solutions while performing reliably.
• Customer Orientation: Builds customer confidence, increases satisfaction, and meets customer needs.
• Interpersonal Skills: Engages effectively with others, builds trust, and establishes credibility.
• Leadership: Motivates, empowers, and encourages others, building consensus and focusing on common goals.
• Teamwork: Attracts, develops, and utilizes teams to optimize results, building trust and resolving conflicts.

Requirements

• High school diploma.
• Two (2) or more years of experience with a Medical Front Desk is preferred.
• Ability to communicate effectively in English, both verbally and in writing.
• Basic computer knowledge.

Professional Requirements

• Meets dress code standards and adheres to policy.
• Completes annual education requirements.
• Maintains regulatory requirements.
• Maintains patient confidentiality at all times.
• Reports to work on time and as scheduled, completes work within designated time.
• Wears identification while on duty and uses the computerized punch time system correctly.
• Completes in-services and returns in a timely fashion.
• Attends annual reviews, department in-services, and staff meetings as scheduled.
• Reads and returns all monthly staff meeting minutes.
• Represents the organization in a positive and professional manner.
• Actively participates in performance improvement and continuous quality improvement (CQI) activities.
• Complies with all organizational policies regarding ethical business practices.
• Communicates the mission, ethics, and goals of the hospital, as well as the focus statement of the department.
• Promotes professional growth of subordinates by sharing knowledge or directing them to appropriate resources.
• Assists other staff members in performing duties that enhance patient care delivery.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

• Regularly required to talk and hear.
• This position is very active and requires repetitive motions, standing, walking, bending, kneeling, and stooping throughout the day.
• Must frequently lift or move items weighing up to 20 pounds.