Patient Access RepresentativeJob Description, Salary, Career Path, and Trends

Sample job description #1

Responsible for patient registration, admissions, and associated tasks which include information collection and validation, and requisitioning of orders and services. Insurance-related tasks include: verification, collection of co-payments, and collection of associated paperwork. Performs administrative functions, scheduling, answering phones, and coordinating general requests.

Essential job functions

• Registers patients and performs all registration-related functions, including explaining and obtaining all necessary patient consents and authorizations in a complete and timely manner, collecting financial paperwork (e.g., patient responsibility statement, etc.), and co-payment as required
• Communicates effectively with patient to assist in access to care by: answering telephone and other incoming communications in a timely and customer-service oriented manner; replying to inquiries, patient needs for information, and other parties clearly and in a timely manner; and, if information is not readily available, follows up with inquiries to responsible party
• Resolves all non-clinical questions within scope of knowledge while providing excellent customer service on the phone and/or in person
• Performs on-going documentation audits for medical necessity, plan of care, and other related tasks or requirements by payors, including Medicare, using a variety of computer-based systems
• If in a procedure-based department, routinely schedules appointments for all procedures educating each patient with pre-exam and if necessary, post-exam requirements within scope. Organizes, generates and distributes patient reminders, results, and recall letters
• Establishes files, maintains information, and scans medical records in a timely and organized manner
• Manages, directs and responds to incoming office correspondence as deemed appropriate, including mail, email, faxes, and telephone calls, and forward queries to the appropriate staff
• Organizes, monitors, and orders front desk supply inventory to assure cost effective departmental spending
• Attends and provides feedback for departmental staff meetings
• Follow the Center for Medicare & Medicare Services (CMS) requirements for checking medical necessity communicates relevant coverage/eligibility information to the patient. Identifies patients who will need Medicare Advance Beneficiary Notices (ABNs) of non-coverage and maintains accurate records of authorizations within the EM
• Completes Medicare Secondary Payer Questionnaire for Medicare beneficiaries in accordance with Centers for Medicare & Medicaid Services (CMS) standards
• Role Models the Principals of a Just Culture and Organizational Values
• Ensures compliance with all applicable HIPAA, EMTLA and Joint commission requirements, providing required associated literature to patients
• Performs other duties as assigned on department and organizational-level

Qualifications

• Experience in healthcare preferred. Previous admitting or clerical experience, and medical terminology are preferred

Sample job description #2

Responsible for front line support to the department. Coordinates and performs front line office activities in an effective and efficient manner for the department. Greets and registers incoming patients, supports the patient check out process and schedules future appointments as applicable.

Job duties

• Hours: 0800-1630; may work 0730-1600, 0800-1630, or 0830-1700
• Responsible for checking patients in for appointments and accurately verifying demographics
• Assures all check-in procedures are completed and monitors patient wait times, communicating changes to the patient as necessary
• Reads and interprets insurance responses
• Understands general guidelines and insurance rank requirement to properly assign primary, secondary, and tertiary insurance per encounter
• Ensures patient receives necessary disclosure and privacy information, as well as obtains necessary legal and financial signatures
• Communicates financial obligations to patients and collects fees at time of service as appropriate
• Communicates the purpose of and completes all necessary regulatory forms with patient
• Completes patient’s visit by scheduling any necessary follow up appointments to include any specialty or ancillary services as possible
• Processes multi-channel messages related to patient and/or physician requests regarding: appointments, referrals, prescriptions, and complaints
• Notifies patient or guarantor of anticipated financial responsibility including copays, deductibles, or coinsurances, and collects accordingly
• Performs cash posting following department guidelines
• Abides by organizational and HIPAA guidelines, privacy practices, patient confidentiality, and patient rights
• Must maintain high regard for confidentiality
• Accurately performs medical record maintenance and releases
• Assists with referrals and pre-certifications, at the time of encounter
• Properly utilizes and maintains patient recall and reschedule lists

Sample job description #3

The Patient Access Representative must be self-driven and able to multitask and prioritize their work. They must have strong communication skills and be able to deal effectively with others. This position is team-oriented and contributes to achieving department goals. In addition, Patient Access Representatives must answer all incoming calls on the hospital switchboard and transfer as appropriate.

Duties and responsibilities

• Obtain accurate and complete demographic and financial information from patients or their representatives through established screening techniques
• Electronically verify patients’ insurance coverage and refer to financial counselor if needed
• Present, explain, and obtain appropriate signatures for legal and compliance related documents
• Scan necessary documents into electronic health record
• Schedule patient appointments or tests/procedures by interpreting physician orders, by patient need, or by established protocols. Provide patient with instructions or preparation for the test/procedure
• Focus on the patient at each interaction, prioritizing tasks with emphasis on patient needs and processing patients using critical thinking skills
• Welcomes all patients and visitors with a smile and provide a positive first impression for the Health System. Provides the requested information and assists to appropriate areas as needed
• Effectively communicate in a timely professional manner
• Answers phone calls promptly and courteously. Directs calls appropriately for patient assistance
• Answers phone calls promptly and courteously. Directs calls appropriately for patient assistance
• Collect copays and payments according to policy. Balance drawer daily. Follow department/clinic cash handling policy

Required education

• Completed 3 years of high school; High School Diploma or GED

Required experience

• 0-2 years hospital clerical, general clerical or customer service related position; Must be able to type 40 words per minute

Sample interview questions

• What experience do you have working with patients and their insurance?
• How would you go about verifying a patient’s insurance eligibility?
• What are some of the challenges that come with working in patient access?
• What do you find to be the most rewarding aspect of this role?
• Describe a situation when you resolved a challenge.
• What are the biggest problems facing patient access in healthcare?
• How would you go about updating a patient’s demographic information?
• Where do you see the future of patient access going within the next ten years?
• What experience would make an ideal candidate for this role?
• Tell me about your availability and typical work schedule.
• What is your availability for overtime?
• Tell me about a time when you had to go above and beyond your job duties.
• What is the most difficult thing about this role?
• What are some of the biggest changes that you have seen in patient access over the years?
• How would you go about communicating with someone on the phone when they are upset?