Patient Access Representative - Adult Primary Care - Riverside

Job Title

Job Title

Job Description

Responsible for accurately registering patients in EMR including validating patient information, verification of insurance coverage, collection of required payments and ensuring the patient's experience is best in class. Relies on established guidelines to accomplish tasks. Works under close supervision.

Responsibilities

1. Customer Service

a. Patients are courteously and appropriately advised of the collection and billing procedures and anticipated charges so as to assist patients in their understanding their liability and responsibility regarding their payment as evidenced by less than 5 complaints a year.

b. All patients/families are courteously welcomed and greeted to the clinic as evidenced by lack of complaints.

c. Questions & concerns from patients and/or family members are answered/addressed in an appropriate manner as evidenced by lack of customer complaints.

d. Patients are informed of their rights and Advance Directives upon request.

e. Patient and insurance information is accurately obtained and edited as necessary in the clinic's computer system, as evidenced by information is accurate at all times.

f. Accurately and efficiently registers patients in Epic; monitors and manages the flow of patients through the clinic utilizing initiative to ensure the patient experience is best in class.

g. Monitors patient schedules and reviews accounts to determine the patient's financial responsibility on account balance and arranges payment plans to collect.

h. Assists patients with access to government and community resources to enhance their access to health care services.

i. Works closely with physicians, nurse practitioners and nursing staff to ensure that referrals to other providers/services/facilities are completed in accordance with payor requirements in a timely manner.

j. Facilitates the patient's access to information including but not limited to MyChart access.

k. Accurately updates patient records as needed.

l. Accurately enters patient charges as necessary.

2. Patient Flow

a. Documentation related to patient referrals is accurately processed at all times.

b. Patient appointments are scheduled and rescheduled appropriately as evidenced by effective patient flow through the clinic at all times.

c. A variety of clerical duties (answer telephone calls, retrieve medical records, records data, type memorandums, etc.) are efficiently completed in a timely and efficient manner at all times.

d. Current patient charts/files and appropriate information are accurately filed as evidenced by ease of the file retrieval process.

3. Payor Regulations

a. Claim edits and denials are researched and discrepancies resolved within 2 days of notification.

b. All information for completing the billing process, including charge information from the physician is researched and discrepancies resolved within 2 days of receipt.

c. Charges are keyed and batches processed daily, and bank/deposit summary is prepared immediately after balancing payment to receipts.

d. Diagnosis and procedures codes are reviewed for accuracy and data is entered into the system at point of service as evidenced by up-to-date records at all times.

e. Patient payments for services rendered are verified and collected from patient 100% of the time.

f. Account balances are verified, and the outstanding balance collected from patients and the daily cash fund reconciled daily.

g. A general knowledge of the health plans, including co-pays, deductibles and co-insurance is maintained at all times.

h. Manages cash in accordance with established policies and procedures to ensure that payments are accurately credited to the patients' accounts and cash is maintained in a secure manner.

i. Meets site collection goals.

4. Other Duties as Assigned:

a. Act as a backup for others in the clinic as needed.

b. Actively supports clinic, hospital and health system initiatives related to improvement in the day-to-day operations.

c. May provides training and orientation for other Team Members when assigned.

d. Other duties as assigned.

Qualifications

Experience: 6 months experience in a customer service/front desk role or a graduate of a front office/medical office program. Bachelor's degree may substitute for experience.

Education: High School Diploma or Equivalent

Special Skills: Professional demeanor, excellent customer service skills, ability to multi-task, critical thinking, demonstrated computer literacy, ability to learn and demonstrate proficiency in Epic during the introductory period.