Sr Patient Access Representative - Pediatrics (Bay Area)

Sr. Patient Access Representative

What we do here changes the world. UTHealth Houston is Texas' resource for healthcare education, innovation, scientific discovery, and excellence in patient care. That's where you come in.

Join our Pediatric Bay Area Clinic as a Sr. Patient Access Representative, supporting primary and specialty pediatric care by managing incoming and outgoing referrals, insurance verification, authorizations, and other patient access needs. This in-person role works closely with patients, families, providers, and payers to help resolve referral and coverage concerns while maintaining accurate documentation and supporting efficient clinic workflows. Ideal candidates will bring strong communication and customer service skills, attention to detail, and knowledge of insurance benefits, eligibility, managed care plans, and healthcare front-end operations.

The position is Monday-Friday, 8 a.m.-5 p.m., and offers the opportunity to play an important role in creating a positive, patient-centered experience for children and their families.

Once you join us you won't want to leave. It's because we reward our team for the excellent service they provide. Our total rewards package includes the benefits you'd expect from a top healthcare organization (benefits, insurance, etc.), plus:

• 100% paid medical premiums for our full-time employees
• Generous time off (holidays, preventative leave day, both vacation and sick time all of which equates to around 37-38 days per year)
• The longer you stay, the more vacation you'll accrue!
• Longevity Pay (Monthly payments after two years of service)
• Build your future with our awesome retirement/pension plan!

We take care of our employees! As a world-renowned institution, our employees' wellbeing is important to us. We offer work/life services such as...

• Free financial and legal counseling
• Free mental health counseling services
• Gym membership discounts and access to wellness programs
• Other employee discounts including entertainment, car rentals, cell phones, etc.
• Resources for child and elder care
• Plus many more!

Position Summary:

Position is responsible for mentoring other employees as a team leader, scheduling patient appointments, ensuring medical necessity compliance, verifying eligibility, and posting payments.

Position Key Accountabilities:

1. Schedules patient appointments and enters required information in the computer system in an accurate and timely manner.
2. Obtains demographic, insurance and financial information from patient or guarantor. Enters information in computer system with a high degree of accuracy.
3. Explains all required forms to the patient or guarantor and obtains the necessary signatures.
4. Ensures medical necessity compliance by obtaining necessary data, reviewing Compliance System, communicating information to patient or guarantor and obtaining necessary signatures.
5. Protects the financial integrity of the facility by collecting patient liability, establishing payment arrangements, discussing payment options and screening for eligibility. Completes complex financial counseling including the review and submission of charity applications. Identifies alternative resources for financial reimbursement.
6. Verifies insurance eligibility and benefits and ensures all notifications and authorizations are completed within the required timeframes.
7. Posts payments in the computer system and generates the appropriate patient receipts.
8. Monitors, reviews and resolves patient account issues on assigned reports. Performs account analysis and trending.
9. Completes quality review and monitors for process improvement opportunities.
10. Functions as a team leader in the department by ensuring daily processes are complete, scheduling employees, providing answers to employee questions and assisting in employee orientation and training.
11. Communicates in an effective and professional manner with Physicians, Care Management, ancillary departments, nursing units, physicians' office staff, insurance companies, as well as patients and their families (all Patient Access customers). Completes thorough and accurate documentation.
12. Adheres to all university policies, procedures, and standards, within budgetary specifications, including time management, supply management, productivity, and accuracy of practice.
13. Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.
14. Performs other duties as assigned.

Certification/Skills:

Ability to multi-task. Proficient typing/keyboarding skills.

Minimum Education:

High school diploma or equivalent.

Minimum Experience:

Four years of experience in a hospital or medical business office setting.

Physical Requirements:

Exerts up to 50 pounds of force occasionally, and/or up to 20 pounds of force frequently, and/or up to 10 pounds constantly to move objects.

Security Sensitive:

This position is a security-sensitive position pursuant to Texas Education Code 51.215 and Texas Government Code 411.094. To the extent that a position requires the holder to research, work on, or have access to critical infrastructure as defined in Texas Business and Commerce Code 117.001(2), the ability to maintain the security or integrity of the infrastructure is a minimum qualification to be hired for and to continue to be employed in that position. Personnel in such positions, and similarly situated state contractors, will be routinely reviewed to determine whether things such as criminal history or continuous connections to the government or political apparatus of a foreign adversary might prevent the applicant, employee, or contractor from being able to maintain the security or integrity of the infrastructure. A foreign adversary is a nation listed in 15 C.F.R. 791.4.

Veteran Information:

Military occupations that relate to the initial selection criteria and registration or licensure requirements for this position may include but are not limited to: 68G, 70E, 0808, 4A0X1

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Residency Requirement:

Employees must permanently reside and work in the State of Texas.