Patient Access Rep - Pediatric Clinic

Job Title: Patient Access Representative 1 - Clinic

Job Summary:

• The Clinic Access Rep 1 is 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.

Experience, Education, Training, Special Skills, and Licensure:

• 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.
• High School Diploma or Equivalent
• 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.

Job Function:

1. Customer Service: This will have been satisfactorily performed when:
   1. 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.
   2. All patients/families are courteously welcomed and greeted to the clinic as evidenced by lack of complaints.
   3. Questions & concerns from patients and/or family members are answered/addressed in an appropriate manner as evidenced by lack of customer complaints.
   4. Patients are informed of their rights and Advance Directives upon request.
   5. 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.
2. Patient Flow: This will have been satisfactorily performed when:
   1. Documentation related to patient referrals is accurately processed at all times.
   2. Patient appointments are scheduled and rescheduled as appropriate as evidenced by effective patient flow through the clinic at all times.
   3. A variety of clerical duties (answers telephone calls, retrieves medical records, records data, types memorandums, etc.) are efficiently completed in a timely and efficient manner at all times.
   4. Current patient charts/files and appropriate information are accurately filed as evidenced by ease of the file retrieval process.
3. Payor Regulations: This will have been satisfactorily performed when:
   1. Claim edits and denials are researched and discrepancies resolved within 2 days of notification.
   2. All information for completing the billing process, including charge information from the physician is researched and discrepancies resolved within 2 days of receipt.
   3. Charges are keyed and batches processed daily, and bank/deposit summary is prepared immediately after balancing payment to receipts.
   4. 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.
   5. Patient payments for services rendered are verified and collected from patient 100% of the time; Account balances are verified, and the outstanding balance collected from patient and the daily cash fund reconciled daily.
   6. A general knowledge of the health plans, including co-pays, deductibles and co-insurance is maintained at all times.
4. Other Duties As Assigned: This will have been satisfactorily performed when:
   1. Other duties as assigned are completed.
   2. Acts as a backup for others in the clinic as needed.