Patient Access Representative I

Patient Access Representative I (PAR I)

At La Clinica del Pueblo, the Patient Access Representative I (PAR I) plays a fundamental role daily by supporting a range of tasks to ensure smooth operations. Patient Access Representative I serve primarily as the entry point for answering incoming phone calls received through our Contact Center and scheduling appointments for our clinical and mental health services. Patient Access Representatives I must display excellent customer service, communication, interpersonal, and organizational skills, and the ability to handle a high volume of calls in a fast-paced environment. This role facilitates accessing care via telephone, messages through the patient portal, and distribution of telephone encounters.

Location: Hyattsville, MD

Department: Patient Services Clinical Operations

Supervisor: Health Center Manager

Classification: Non-Exempt/Hourly

Qualifications

Required Education and Experience

• High school diploma or GED required; Associate degree preferred.
• One (1) year of exceptional internal and external customer service and ability to work with diverse, underserved populations and the LGBTQ+ community.
• One (1) year of experience with insurance verification and benefits eligibility. In place of one (1) year of experience, a combination of understanding and articulating insurance benefits and willingness to learn.
• Ability to follow La Clinica's Standard Operating Procedures (SOPs) and adhere to Scheduling Guidelines.

Preferred Education and Experience

• One to three (1-3) years of experience in a healthcare or call center preferred.
• Multi-line phone system; Dialpad a plus. Excellent verbal and written communication, professional telephone manner, interviewing, and interpersonal skills to interact with patients, families, members of the health care team, and external agencies.
• Analytical and critical thinking skills to resolve conflicts and problem-solving to meet the patient's needs. Data entry skills with the ability to check the accuracy of detailed work.
• Maintain high productivity and work well in a team environment.
• Bilingual in English and Spanish with effective verbal and written communication skills.

Required Skills/Abilities/Certifications/Licenses

• Compassion to assist patients and caregivers in challenging situations.
• Strong organizational skills to keep patient information confidential and organized.
• Problem-solving skills for scheduling conflicts, missing documentation, and other challenges.
• BLS or CPR certification or willingness to obtain within 90 days of employment.

Preferred Skills/Abilities/Certifications/Licenses

• Knowledge of medical terminology and practices.
• Ability to maintain patient confidentiality and adhere to HIPAA regulations and PHI.
• Ability to function in high-volume, multiple-task environments in a closely shared workspace.

Primary Essential Duties and Responsibilities

• Ensures that all documentation provided to the patient is correctly filled out and signed by the responsible party according to the workflow. Answer any questions as needed.
• Attends required all-staff meetings and LCDP activities training to increase/maintain skills and complete competency checklists within 90 days of employment and annually. Participates in disaster programs and monthly drills as appropriate.
• Maintains current professional skills and continues professional growth to enhance the performance and image of the organization.
• Actively participates in the Patient-Centered Medical Home (PCMH) change process to support the organization's transformation.
• Participating in ongoing training to stay updated on medical procedures, policies, and regulations.
• Completes assigned tasks and responsibilities within established guidelines and scope of practice.
• Collaborating and communicating with clinical staff to ensure smooth patient flow and efficient service delivery.
• Ability to communicate affirmingly, respectfully, and efficiently with staff and patients.
• Adheres to La Clinica del Pueblo's Code of Ethical Standards, ensuring excellent internal and external customer service and patient experience throughout all interactions.
• Enforce LCDP's policies and procedures to patients; seek management support as required.
• Performs other tasks as needed under the direction of the Health Center Assistant Manager.

Front Office Customer Service

• Checks patients in for their appointments.
• Assisting patients with pre-registration and insurance verification.
• Informs, collects, and processes patient payments, including SFS, account balances, copays, diabetes supplies, prenatal vitamins, and patient donations. Refer patients to the billing department for payment plans or insurance-related inquiries. Reconciles daily cash reports.
• Provide educational materials related to their visit.
• Enrolls and directs patients to the patient portal; reminds established patients that they can access their medical information and request appointments and medication refills.
• Complete administrative tasks, including reviewing and managing tasks assigned to the Patient Access Representative team.
• Schedule the patient's follow-up and any upcoming pre-visit laboratory orders - schedule the patient's next appointment(s) and necessary laboratory tests before the next visit according to the protocol of each condition or as directed by the provider.
• Ensure patients have necessary referrals, appointment summaries, prescriptions, scheduled follow-up appointments, recall system entry, and any required documentation before departure.

Contact Center

• Handle multi-line telephone systems courteously, directing calls to the relevant team and documenting patient interactions in telephone encounters (TE) in electronic health records (EHR).
• Promptly respond to incoming calls, Healow messages (Patient Portal), voicemails, pharmacies, and outside agencies seeking assistance, ensuring exceptional service delivery.
• Contact unconfirmed patients on the schedule for whom eCW has not reached out for confirmation.
• Assisting patients with pre-registration and insurance verification.
• Schedules ASL and language interpreters when appointments are scheduled.
• Manage appointment status calls, including rescheduling and cancellations of medical appointments.
• Enrolls and directs patients to the patient portal; reminds established patients that they can access their medical information and request appointments and medication refills.
• Coordinate pending provider recalls and arrange appointments accordingly.
• Completes pre-registration for patients, schedules appointments with Patient Access Representative II, and advises patients on necessary documentation to complete the registration process, including insurance enrollment or renewal requirements.
• Adhere to La Clinica's Scheduling Guidelines when booking the Clinical Services and Mental Health team templates. Communicate all unforeseen challenges to the Health Center Manager.

Physical Requirements

• Prolonged periods of sitting at a desk working on a computer and handling a high volume of incoming and outgoing calls.
• Must be able to lift at least 15 pounds at times.

Supervisory Responsibilities: None