Access Center Representative I

Access Center Representative I

Serves as the primary point of contact for the community calling the District for a wide variety of questions and information requests. Answers calls from the hospital's main telephone numbers and calls routed from the physician offices and departments for scheduling. Obtains authorizations for primary care and specialist consults, diagnostic imaging and other referrals as assigned.

Access Center tasks include:

• Scheduling
• Pre-registration
• E-verifying
• Determining and collecting the patient's out-of-pocket expenses (co-pays, deductibles, etc)
• Signing patients up for self-service options
• Authorizations

Essential Duties and Responsibilities

• Schedules appointments for primary care, specialty providers and hospital services.
• Provides information to callers including directions, addresses, telephone numbers, appointment times, etc.
• Answers incoming phone calls to hospital's main numbers, routes calls appropriately.
• Serves as the primary point of contact for patients scheduling outpatient appointments in the District; may be via telephone or electronic means.
• Educates patients on various self-service programs offered by the District (patient portal, etc.).
• Works with patients, families, providers, clinical and non-clinical staff to coordinate the patient's experience through-out the process of accessing healthcare.
• Interviews patients to effectively schedule and register.
• Collects, verifies and updates patient demographics, guarantor information and insurance information.
• Establishes eligibility and verifies benefits.
• Determines and collects co-pays and estimated out-of-pocket expense as appropriate.
• Advises patient and families of hospital financial policies.
• Refers to financial counselor as appropriate.
• Obtains authorizations if assigned.
• Follows established parameters to ensure procedures, treatments, tests, and appointments are scheduled with the required amount of time and with the appropriate resources.
• Articulates information in a manner that patients, guarantors, and family members understand.
• Key contributor to patient satisfaction initiatives by participating in process improvement activities as well as providing a high quality contact experience for the patient with every interaction.
• Provides the patient with preparation instructions pertinent to their service.
• Communicates regularly with patients, families, care-givers, providers, clinical and non-clinical staff as necessary for the completion of authorizations.
• Contacts the insurance company and requests authorization; documents completely the interaction in the Electronic Medical Record (EMR), including person(s) spoken to, outcome and any authorization numbers.
• Follows up with providers and patients regarding denied authorizations or requests for additional information.
• Reads and interprets provider notes in order to obtain authorization.
• Confirms medical necessity of ordered procedure(s).
• Prioritizes tasks and follows work through to completion.
• Follows established parameters to ensure procedures, treatments, tests, and appointments are authorized completely.
• Navigates multiple computer applications and interprets financial and insurance information.
• Performs to department productivity and accuracy expectations.
• Maintains and updates knowledge regarding all types of insurance and healthcare coverage, utilizing reference materials provided.
• Demonstrates System Values in performance and behavior.
• Complies with System policies and procedures.
• Other duties as may be assigned.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Supervisory Responsibilities

No supervisory responsibilities

Minimum Education/Experience

No educational requirement and 6 months to 1 year of experience

Required Licenses/Certifications

None

Other Experience/Qualifications

• Demonstrates clear, courteous and pleasant communication skills with appropriate usage of grammar, pronunciation.
• Excellent customer service skills.
• Self-motivated and goal oriented with the ability to multi-task.
• Team oriented.
• Positive, open-minded, and focused on continuous improvement.
• Ability to learn new processes, procedures and software programs quickly, while demonstrating attention to detail and accuracy.
• Analytical and problem solving skills.
• Navigate multiple applications simultaneously