What Does a Patient Access Representative Do?
Patient access representatives are healthcare professionals who welcome and register patients at a healthcare facility, such as a hospital or clinic. These professionals work in a variety of settings, including emergency departments, outpatient clinics, and specialty care practices. As the first point of contact for patients and their families, these individuals provide excellent customer service and collect and verify personal information. They are responsible for ensuring that all the required documentation is accurate, including insurance information, medical history, and demographic data. Patient access representatives must possess excellent communication, interpersonal, and organizational skills and a high level of attention to detail.
The patient access representative’s role is critical in ensuring that patients receive timely and appropriate medical care. They manage patient flow, schedule appointments, and coordinate with other healthcare professionals as part of their duties. In addition, they work closely with insurance companies to verify coverage and inform patients about any out-of-pocket expenses. These professionals may also collect copayments and other fees and handle patient financial accounts. As they handle sensitive medical and personal information, they must adhere to high standards of professionalism and confidentiality.
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National Average Salary
Patient access representative salaries vary by experience, industry, organization size, and geography. To explore salary ranges by local market, please visit our sister site zengig.com.
The average U.S. salary for a Patient Access Representative is:
Patient Access Representative Job Descriptions
Crafting the perfect job description may be the key to finding an exceptional patient access representative. To help you with your recruiting search, our team has put together some examples from past openings.
The patient access representative provides high-level administrative support to the patient access team, including completion of patient medical insurance eligibility, processing benefits, and referral authorizations for patients.You will need to complete daily patient entry, intensive care unit (ICU) listing, or census verification activities to ensure proper patient identification by collecting, entering, and verifying data in order to remove duplicate registrations, verify insurance eligibility with third-party payers, coordinate benefits information for patients/families, and file claims on behalf of the patient with various public or private health insurance carriers. You may also be tasked with updating demographic records in the computer system, maintaining family contacts with insurance companies to resolve claim and benefit issues, assisting patients with questions or concerns related to their hospital stay, or serve as a liaison between patients and other departments within the hospital.
Typical duties and responsibilities
- Answer phone and schedule appointments
- Greet patients and visitors to the office
- Record patients’ medical history and personal information
- Escort patients around the office
- Submit insurance forms
- Copy, file, and maintain paper and electronic documents
- Handle incoming and outgoing correspondence
Education and experience
Patient access representatives need to have a high school diploma or equivalent. Computer and typing skills and knowledge of the health-care industry are helpful. Employers usually provide on-the-job training that covers specific duties.
Required skills and qualifications
- Computer skills, including Microsoft Office Suite (Word, PowerPoint, and Excel)
- Experience with electronic health records (EHRs)
- Strong customer service skills for dealing with patients
- Discretion and the ability to handle confidential information
- Organization skills and the ability to multitask
- Compassion and a calm, professional demeanor
- Keen attention to detail
- HIPAA certified
- Knowledge of insurance benefits
- 3+ years of experience working as a patient access representative
- Strong interpersonal skills
- Ability to solve claims in a fast manner
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.
- 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
- Experience in healthcare preferred.
- Previous admitting or clerical experience, and medical terminology are preferred
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.
- 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
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
- Completed 3 years of high school; High School Diploma or GED
- 0-2 years hospital clerical, general clerical or customer service related position; Must be able to type 40 words per minute
Candidate Certification to Look For
Certified Healthcare Access Associate (CHAA)
This certification validates that a candidate’s knowledge and skills align with industry standards – showing that they are reliable, accountable, and trusted patient access professionals dedicated to improving patient experience.
How to Hire a Patient Access Representative
Consider the following when hiring a patient access representative:
- Recruiting: Do you have the internal resources and tools to source and recruit for this role successfully?
- Complexity: Do you need a senior professional, or will mid, or even junior-level skills suffice?
- Duration: Is this a one-time project, or an indefinite need?
- Management: Can you effectively direct the work effort?
- Urgency: Are there any deadlines associated with this need?
- Headcount: Do you have the budget and approval for an internal employee, or should you consider alternate options?
Answering these questions will help determine the best course of action for your current hiring need. Fortunately, various great options exist for every scenario, no matter how unique. We recommend the following options when hiring a patient access representative:
1. Use 4 Corner Resources (or another professional recruiting firm)
The heavy lifting is done for you when working with a top-tier staffing company like 4 Corner Resources. We source, screen, recruit, and deliver only the most qualified candidate(s), saving you significant time and effort throughout the hiring process while you remain focused on your core business. Understanding your needs and ensuring the right candidate for the position is the key to our success.
This is the best route to take when:
- You need to fill the position quickly
- You want access to a vast talent pool of high-quality, prescreened candidates
- Your position is suited for temporary hiring services, contract staffing, or contract-to-hire recruiting, and you intend to direct the work activity.
- You are hiring an employee as a direct placement but aren’t able to recruit effectively or efficiently with your internal staff.
- You aren’t familiar with current salary rates, market trends, and available skill sets
2. Advertise your opening on a top job board
Your best option may be to advertise your opening on a proven job board. There are many widely used job sites out there that draw visits from qualified candidates. If you have someone internally who can dedicate the time and energy to sort through applications and screen individuals effectively, this can be a great choice.
We recommend using a job board when:
- Your internal recruiting team has the knowledge and experience to assess candidate qualifications
- You are hiring a direct employee and have time to manage the entire recruiting effort
- You have a process for receiving, screening, and tracking all resumes and applications
- You are prepared to respond to all applicants
We recommend using CareerBuilder when hiring a patient access representative:
CareerBuilder has been a trusted source for hiring since 1995. Reach 80+ million unique, diverse U.S. job seekers annually by posting your jobs through their talent acquisition channels. Through CareerBuilder, you can engage candidates and drive them into your sourcing pipeline. We recommend using CareerBuilder for hiring when you have the internal resources and processes to review, screen, and reply to all applicants.
3. Leverage your internal resources
You can utilize your own website, social media, and employees to assist in your search for top candidates.
A company website posting should be the first step in notifying prospective candidates that you are hiring. Social media can also be a powerful tool for spreading the word about your new opening. As far as exposure is concerned, this option can be as good as some job boards when you have a large enough following across various platforms, like LinkedIn, Instagram, Facebook, TikTok, and Twitter.
Current employees are every organization’s greatest asset. Encourage your internal team to promote job openings to their network by offering cash and other incentives.
We recommend these options when:
- Your brand has great name recognition
- You can consistently monitor and respond to candidate activity through your website and social media accounts
- You have a process in place to quickly and broadly communicate job openings and requirements
- You have an effective employee referral program in place
If you aren’t sure which path is best, schedule a discovery call today with our seasoned recruiting professionals. The 4 Corner team is on standby to help you find the best option for your unique hiring need.
Sample Interview Questions
- What is your experience with interacting with patients and their families in a healthcare setting?
- How have you entered and accessed patient information in electronic medical records?
- How do you schedule appointments and manage patient flow to ensure timely and efficient care?
- What steps do you take to ensure accurate and complete patient information, such as insurance coverage and medical history?
- How do you protect patient privacy and ensure the confidentiality of patient information?
- If a patient’s insurance coverage is unclear or doesn’t cover the services they need, what steps should you take to ensure that they are aware of their financial responsibilities?
- Are you familiar with managing patient accounts and collecting payments, including situations when patients are unable to pay?
- Do you have experience coordinating the care of patients with other healthcare professionals?
- How do you ensure excellent customer service for patients and their families despite challenging or difficult circumstances?
- Do you handle multiple tasks at once, such as registering patients, answering phones, and handling administrative tasks, while maintaining accuracy and detail-oriented behavior?