Patient Access Rep Clinic

CommonSpirit Health•Seattle, WA

About The Position

The Patient Access Representative manages administrative duties for the patient intake process in a clinic, following established guidelines. The role involves interacting with patients in person and by phone to facilitate check-in and check-out, collect information and payments, verify insurance, schedule appointments, and process referrals and authorizations. Success in the role requires critical thinking, strong customer service, and knowledge of insurance, billing, and medical terminology to support a seamless, high-quality patient intake experience. The representative registers patients and verifies demographic, insurance, and other information; copies and scans access-related documents into the appropriate areas of the electronic medical record; records non-clinical charges; collects and posts payments; reconciles payments and cash drawers; and prepares outstanding work for the next clinic day. The role also monitors and resolves registration issues, corrects patient information, checks insurance eligibility, resolves work-queue edits, and processes referrals and pre-authorizations before visits when required. The representative explains health plan policies, answers billing and insurance questions, obtains and explains cost estimates and benefit coverage, and communicates referral denials or requests for additional information. The position also coordinates appointments and ancillary services, follows up with patients about referrals and missed appointments, documents relevant information, and arranges for special needs such as transportation and interpreters.

Requirements

One year of customer service work experience.

Nice To Haves

Two years of customer service work experience.
Healthcare or Call Center experience.

Responsibilities

Register patients and perform check-in and check-out, recording and verifying demographic, insurance, and other required information.
Follow registration guidelines, ensure requirements are satisfied, identify deficiencies, resolve non-complex issues, and escalate other issues as appropriate.
Conduct routine insurance eligibility verifications.
Copy and scan patient access documents into the correct locations in the electronic medical record.
Record non-clinical charges, including fees for forms, depositions or attorney services, and retail items.
Collect and post co-payments, co-insurance, cash, and other payments due; reconcile payments, balance and close cash drawers, and complete end-of-day preparation.
Monitor and resolve registration and other front-end issues before patient visits, update missing or incorrect information, conduct eligibility checks, and resolve work-queue edits.
Process referrals and pre-authorizations for diagnostic testing, therapy, surgeries, procedures, and specialty care before the patient is seen, according to requirements and patient preference.
Explain health care plan policies and procedures to patients, employees, and physicians; answer billing and insurance questions, obtain cost estimates when requested, and explain benefit coverage.
Notify physicians and patients when referrals are denied or when a second opinion or additional information is needed.
Update patient medical records and coordinate with referring clinics as needed to support patient care.
Schedule patients with multiple providers or clinics when assigned to Call Center work; coordinate clinic visits based on authorized referrals.
Gather and document insurance eligibility information and conduct routine verifications during patient conversations.
Contact patients to confirm referral appointments and follow up to reschedule missed or cancelled appointments; document no-show reasons and notify management when further action may be needed.
Arrange for special or ancillary patient needs, including transportation and interpreters.