Patient Access Representative Job Descriptions, Average Salary, Interview Questions

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

Preferred qualifications

• 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.

Job duties

• 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

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

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