Member Access Representative - Employee Health Center

Parkland Health

9d•Onsite

About The Position

The Member Access Representative is at the forefront of creating exceptional patient experiences and health outcomes that lead to happier, healthier, and more engaged members and their eligible dependents. As a key contributor of the clinic team, the Member Access Representative is accountable for providing first contact resolution to all care access needs, such as appointment scheduling, referrals, clinical message requests, health information documentation, financial assistance, and customer service. This role is dedicated to delivering exceptional care to the Dallas community as part of one of the nation's largest public hospital systems, focusing on excellence, innovation, and patient-centered service.

Requirements

Must have completed training through an accredited Medical Assistant training program or obtain training within 18 months of hire date.
Must have a High School diploma or GED.
Must have three (3) years of medical office, business office, call center or customer service experience.
Must be able to work collaboratively with colleagues to deliver patient/customer services that exceeds patient expectations as evidenced by patient satisfaction scores.
Must be able to communicate effectively with all hospital personnel, patients and visitors.
Must be detail oriented and have sharp analytical skills to resolve access issues as related to multiple groups including third-party payors, physicians, patients and the system.
Must be able to demonstrate competency required as applicable to specialty area.
Must have familiarity with diagnostic ICD-10 CM coding and HCPCS-CPT4 procedure codes.
Must have working knowledge of medical terminology.
Must be able to demonstrate basic clerical skills and working knowledge of standard office equipment.
Must be able to solve problems within the guidelines of established policies and procedures.
Must demonstrate a positive demeanor, good verbal and written communication skills, and a professional appearance and approach.
Must be able to adjust to multiple demands, shifting priorities and rapid change.

Nice To Haves

Patient registration and appointment scheduling experience preferred.
Medical Terminology Course Certificate and/or Medical Assistant Certification preferred.
Bilingual skills preferred.

Responsibilities

Assists patients with complex scheduling needs to ensure appointments are scheduled as expeditiously as possible.
Ensures referral is approved prior to scheduling, if referral required.
Reviews specialty clinic referral note for scheduling instructions.
Ensures appointment notes are clear and concise.
Demonstrates knowledge of clinic scheduling rules and pre-clinical requirements for each clinical area.
Contacts medical provider or clinical area, as needed, for clarification.
Places patient on the recall or wait list when appointments are not available.
Communicates patient’s options for health care while on the recall/wait list.
Works recall or wait lists contacting patients for appointment scheduling, as assigned.
Gathers, verifies and documents data elements including patient demographics and funding information to ensure that patient information is complete and accurate prior to the date of service.
Performs a thorough search prior to creating a new medical record number to prevent duplicate medical record numbers.
Updates demographics as needed.
Communicates to the patient the patient’s financial responsibility including co-payments and fees for each clinical area based on financial classification and whether an authorized referral is required for service.
Reviews the patient account to determine whether patient is funded or not.
Completes benefit verification function prior to scheduling as required by financial classification.
Verifies assigned Primary Care Physician per managed care plan.
Educates patient on financial assistance process.
Refers non-funded patients to financial counseling.
Enters referrals on-line, as assigned, with 3% or less error rate.
Assists other Member Access Representatives with more difficult referral entries.
Obtains clinical assistance as needed for issues identified on referrals.
Pends referrals based on financial classification to appropriate staff for clinical and financial clearance as required.
Obtains clinical and financial data for outside provider referrals to Parkland and communicates information to appropriate staff for disposition.
Manages clinical denials of referrals.
Ensures referral documentation is clear and concise.
Identifies need for a telephone encounter during patient call.
Reviews past/current encounters to prevent duplication.
Completes addendums as needed.
Documents necessary information (signs/symptoms, medication name, contact information, etc.).
Routes telephone encounters appropriately.
Maintains a positive working relationship and effective communication with patients, health care providers, clinic personnel, management and other employees to ensure interactions are professional in manner and promotes a positive image for Parkland.
Supports all clerical, health information documentation, and other business operations tasks as assigned by management.
Works scheduling and denial work queues between calls and as assigned contacting patients for scheduling and notifying referring provider for denials.
Enters data into Access database as required.
Completes special projects as assigned by management.
Serves as a resource for training staff in the area.
May serve in a leadership role on department committees/projects.
Provide education to patients/caregivers on how to properly connect for virtual services (Telehealth).
Directly engage patient to assess telehealth experience and feedback (Telehealth).
Identifies ways to improve work processes and improve customer satisfaction.
Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland.
Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure.
Integrates knowledge gained into current work practices.
Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area.
Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans.
Seeks advice and guidance as needed to ensure proper understanding.