Senior Patient Access Representative

Pay Range: $21.17 - $42.35

About the Role

The Senior Patient Access Representative will report to the Patient Access Supervisor or Manager and provide patient services and administrative support in ancillary operations. This role acts as a knowledge source for registration by assisting in daily process outcomes of the department, supporting the team with training and problem-solving to enhance registration performance. The Senior Patient Access Representative will be responsible for the continued development of staff, working with management to develop training programs, and assisting with compliance with the quality assurance program. This position interacts with parents, patients, physicians, and other staff under moderate supervision in a courteous manner and provides assistance to other employees within their department as well as other departments.

Responsibilities

• Collect and verify all demographic information to ensure accuracy.
• Provide required notification of scheduled and unscheduled services according to insurance provider requirements.
• Schedule patients for ancillary appointments.
• Float to ancillary patient access areas for coverage (ED, RAD, IP, LAB, AMSAC, etc.).
• Complete a minimum of one complex access function (Complex Scheduling, Bed Management, and Complex Mentorship).

Patient Services

• Ensure accuracy of scheduling patients using the applicable scheduling system for the department: schedule routine and add-on exams; schedule complex radiological exams prior to the patient's arrival.
• Complete computer-aided, online registration screen with parent/guardian via telephone or in person in a professional and courteous manner.
• Complete bedside registration based on assigned workspace.
• Update systems as needed in accordance with department standards for registration accuracy, including bedside registration for ED patients and when appropriate for inpatients.
• Update scheduling systems with cancellations and no-shows by close of business; reschedule appointments for patients who did not show or for ancillary services cancellations by providers.
• Schedule follow-up appointments at checkout.
• Greet patients and parents courteously; arrive patient in the appropriate system based on department policy.
• Obtain required consents for the department and ensure distribution of compliance-related materials (e.g., HIPAA Privacy Notice, Patient Rights).
• Obtain a copy of the insurance card and photo ID to be stored in the medical record (copy or scan activity required).
• Ensure applicable insurance company and CNMC HIM department receive copies of appropriate forms/documentation.
• Complete all documentation in accordance with department policy and procedure.
• Collect and record co-payments, deposits, and payments in full, providing payers with receipts; help the department meet 85% of the collection target.
• Respond to patient portal work lists (e.g., appointment requests, fax queues, email requests, etc.).

Information Verification

• Verify insurance eligibility using the applicable eligibility system; ensure managed care carve-outs (lab and radiology) are adhered to.
• Notify insurance companies or review agencies as required by hospital contract and document notification as defined by policy.
• Advise leadership of any authorization issues at the time of check-in, including identifying surgeries/diagnostic testing without authorizations and contacting the provider’s office or scheduling coordinator to address issues timely without delaying patient care.
• Notify parents of the need for completed insurance referral forms or pre-authorization prior to scheduled/unscheduled appointments.
• Discuss co-payment, deposits, payment in full, or past due balance collections with parents in a professional and courteous manner.
• Counsel parents or refer them to the Financial Information Center (FIC) for establishing payment schedules or methods of payment.
• Verify insurance information is complete prior to the procedure and collect and verify pre-authorization/referral information, obtaining authorizations 5 days in advance of service.
• Interface with insurance companies as needed; document activity in “account notes” following standards set by the department; complete the complex authorization process for IP services.
• Utilize all systems where patient information may be to verify that systems are in sync.

Bed Management, Billing/Charts Preparation, Daily Reconciliation

• Review and print department schedules, ensure the appropriateness of scheduled appointments, and backfill open slots.
• For ancillary services, ensure all applicable orders/scripts/referrals are obtained prior to services being rendered.
• Appropriately clear all walk-ins and ensure scheduled appointments are linked to the scheduling system.
• Retrieve department charts for existing patients and prepare charts for new patients.
• Assign beds to patients in accordance with established criteria and availability; communicate bed assignments to sending and receiving units.
• Contact AD Coordinator regarding transfers from other hospitals; process all admissions and transfer requests accurately and timely.
• Notify the insurance company of admission in a timely manner.
• Discharge active recurring accounts for patients being admitted; follow policies and procedures for specialty discharges (e.g., WRTC).
• Reconcile charge capture against schedules.
• Maintain departmental requirements regarding cash controls and collections; reconcile daily cash receipts/collections and submit to the manager.
• Ensure that quality registration work queues are addressed timely (3-4 days in advance of ancillary sessions; 5-7 days for areas with procedures requiring authorizations).

Performance Improvement, Mentoring, and Training

• Provide input to the manager about registration errors for ongoing training purposes; monitor and correct registration errors.
• Monitor QA reports to identify training needs and ensure standards are met.
• Work with the manager to reduce registration and authorization denials; research and resolve missing charges.
• Provide expertise to peers throughout the institution; train and mentor PAR staff (may conduct training sessions); provide workflow guidance.

Office Support

• Answer telephone and address caller needs appropriately; avoid transferring calls for better service to families; meet department standards relative to ACD policies if applicable; manage voicemail messages within the same business day.
• Distribute mail; work returned mail as needed.
• Responsible for information distributed via email; check work email a minimum of 3 times daily and respond to inquiries within 24 hours (or next business day).
• Maintain office files and office supplies at PAR levels.
• Maintain a clean reception area and workspace.
• Provide other support as needed.

Requirements

• High School Diploma or GED (Required).
• 3 years of related experience (Required).
• Broad knowledge in administrative processes and customer service skills.
• Computer knowledge necessary; Microsoft Office Experience Preferred (Word & Excel).
• Complete Patient Access training curriculum and pass all competency assessments.
• Ability to type a minimum of 35 words per minute.

Benefits

• Comprehensive health coverage, including medical, prescription, infertility, and transgender health services.
• Generous paid time off, including vacation accrual from day one, sick leave, holidays, and a personal day.
• Financial wellness support, including a 401(k) plan and healthcare and dependent care spending accounts.
• Employer-paid life, AD&D, and long-term disability coverage, with optional supplemental plans.
• Additional perks, including tuition assistance, fitness resources, employee assistance, commuter benefits, and more.

Why Join Us

• Nationally Recognized Excellence – Consistently ranked among the Top 10 Children’s Hospitals in the nation by U.S. News & World Report.
• Leading Pediatric Care – One of the largest and most comprehensive children’s hospitals in the country, offering nationally ranked specialties and cutting-edge treatments.
• Innovation & Research – A premier academic medical center with a strong commitment to pediatric research, education, and advancing the future of child health.
• Mission-Driven Culture – Dedicated to providing family-centered care while fostering a collaborative, supportive environment for clinical teams.

The disclosed salary range includes the minimum and maximum rates within which Children’s National believes an individual’s base pay rate will fall for this position. The exact pay rate will be based on a variety of factors in alignment with Children’s National compensation philosophy, including the individual’s combination of prior work experience, level of education, knowledge, skills, and other qualifications.