Patient Access Representative Generalist

Northwestern Medical Center • St. Albans, VT

10d • Onsite

About The Position

Northwestern Medical Center is recruiting a Patient Access Generalist. This full-time position (80 hours bi-weekly) involves varied shifts, including weekends as needed, and requires floating to various positions within the department. Northwestern Medical Center's mission is to provide exceptional healthcare to our community. We value our employees, their families, and their overall health and well-being, offering a generous benefits package designed to help our people stay healthy, balance work and life, protect assets, and plan for a secure financial future. The Patient Access Representative Generalist provides comprehensive patient access, communication, and financial clearance support across multiple functional areas including Patient Access Registration, Switchboard Operations, Pre-Encounter Services, and Prior Authorization. This role is designed to be fully cross-trained and highly adaptable, floating between assigned areas to meet operational needs, ensure continuity of service, and support patient flow. It facilitates accurate and timely patient registration, scheduling, insurance verification, financial counseling support, prior authorization activities, and hospital communications by utilizing strong critical thinking, customer service, and problem-solving skills. The Float/Generalist serves as a key resource to maintain service levels during fluctuations in volume, staffing gaps, or special coverage needs, while maintaining compliance with regulatory, payer, and organizational requirements.

Requirements

• High school diploma or equivalent required.
• Three years’ experience in a medical office preferred.
• Knowledge of medical terminology and typing skills required.
• Must be detail oriented and able to handle multiple tasks.
• The ideal candidate demonstrates flexibility, accountability, and a broad understanding of patient access operations, delivers consistently excellent customer service, and supports patients, providers, and staff across the continuum of care through effective communication, attention to detail, and efficient use of systems and resources.

Nice To Haves

• Associates degree preferred.

Responsibilities

• Accurately and precisely enters registration information for patients.
• Acquires any patient specific paperwork and/or test results, including the written order prior to patients appointment or bed assignment.
• Captures required necessary patient information and signatures from parent/guardian for minor patients.
• Correctly obtains insurance information, completes Medicare questionnaire if applicable.
• Explains to the patient the content of certain registration and insurance forms that require signatures.
• Queries specific insurance companies to verify insurance benefits and/or requirements.
• Identifies which patients owe a co-pay or balance, requests and collects the co-pay/balance in a polite and private manner.
• Utilizes problem solving and decision-making skills to respond appropriately to phone calls from patients, families, physicians, payors, lawyers, and/or other health care professionals.
• Coordinates and documents daily patient reminder calls for upcoming appointments and procedures.
• Identifies and reiterates to patient necessary preparation for upcoming appointment, if applicable.
• Schedules patients for surgical procedures.
• Assembles charts and acquires any required documentation, if applicable.
• Actively and independently assesses the waiting room for patient flow, requesting additional resources as needed.
• Reports issues to supervisor/shift supervisor as needed.
• Keeps waiting area clean and free of debris.
• Answers incoming calls into the hospitals main telephone line, answering service phone lines, and internal hospital operator phone lines.
• Assesses the needs of the caller and utilizes protocols to answer questions of the caller, transfer the caller to the appropriate destination, transcribe a message, send a page, or facilitate other types of communication.
• Communicates with patients, team members, the public, and management in an accurate and timely manner evidenced by, talking with and listens to patients/team members, reporting pertinent and concise information, and protecting confidentiality of patient/colleagues.
• Applies critical thinking skills and considers alternatives by organizing multitask workload and high priority calls and alerts, prioritizing tasks/work, seeking assistance when required, collecting/integrating data from multiple sources.
• Utilizes the daily log communication tool in a legible, and understandable format to ensure effective communication between hospital operators.
• Assists in maintaining up to date information in rolodex for quick reference.
• Maintains call list in an accurate and legible manner to ensure highest level of emergency preparedness and customer service.
• Double checks the list to ensure accuracy.
• Distributes call schedule accordingly to hospital users as required.
• Communicates with physician and non-physician call schedulers to obtain up to date call information and completed schedules.
• Receives information about changes to on call coverage, and documents changes accurately.
• Monitors and prioritizes internal hospital emergency phone line, radio, and all alarms.
• Effectively utilizes protocols, critical thinking, and effective judgement to respond to all emergencies, and alarms.
• Completes overhead paging as required, speaking clearly, and utilizing scripting when appropriate.
• Accurately completes and files emergency response checklist as required to ensure consistent and highly reliable emergency response.
• Completes timely scanning of patient documents into electronic record.
• May be cross trained in the processing of incoming faxes to include, monitoring incoming fax buckets, reviewing documents, and accurately routing/uploading documents based on protocols.
• May be cross trained to complete reference lab registrations to include entry of registration/insurance information, insurance verification, and order scanning.
• Completes registrations to meet department accuracy and error resolution key performance indicator standards by maintaining >90% Final Accuracy and >75% Error Resolution.
• Demonstrates compliance with specified insurance requirements.
• Collects pertinent demographic and financial information according to HIPAA guidelines.
• Registers and pre-registers ambulatory, outpatient, and inpatient visits for all locations.
• Appropriately documents registration and pre-registration activities.
• Ensure patient is directed to correct clinical area for service.
• Ensures that patient/guardian signatures are obtained on consent forms, Notice of Privacy Practice, Package Price Agreements, ABN’s, and other documents as appropriate.
• Always copies/scans both sides of insurance card and photo id.
• Verifies insurance eligibility and ensures pre-cert and/or authorization has been obtained as required.
• Explains insurance benefits to patient so that financial obligations are understood.
• For Medicare patients, completes the Medicare Secondary Payer Questionnaire (MSP) per CMS regulations, demonstrating the ability to determine primary/secondary insurance coverage based on the patient’s responses to the questions.
• For Medicare patients, checks the medical necessity of expected services.
• Completes an Advance Beneficiary Notice (ABN) when CMS does not consider services medically necessary.
• Collects all pre-determined self-pay sums at time of registration.
• Assists patient/organization in meeting financial goals.
• Provides initial counseling to patients on NMC and other financial assistance programs, including local, state and federal programs.
• Provides appropriate paperwork and refers patients to Financial Counselors as needed.
• Assists patients, physician offices, and hospital departments by determining needs, scheduling, rescheduling, or canceling appointments, or referring patient to appropriate personnel.
• Codes and enters orders and appointment information into files and scheduling database.
• Communicates physician requests for emergency interruptions of the schedule in progress.
• Reviews entries to ensure accuracy and completeness.
• Schedules patients to NMC departments based on pre-determined appointment arrangements, templates, and protocols to serve an adequate number of patients as established by departmental protocols.
• When scheduling appointments, carefully screens patients for appropriate physician orders if applicable, and informs patient of information that must be presented at time of visit.
• Handles any necessary arrangements needed to optimize the patient experience on the date of service including securing and scanning orders, determining special needs, facilitating insurance pre-cert/authorization with providers, performing pre-service collections, and ensuring necessary supplies are available.
• Consistently Manages gaps in schedule to ensure maximum appointment utilization.
• When preferred appointment date and time is not available to the patient, adds patient to the appointment waitlist.
• Monitors canceled appointment and retrieves appointments from the waitlist as needed.
• Responsible to follow up on any no show visits.
• Schedules incoming referrals.
• Handles a high volume of inbound and outbound phone calls.
• Maintains a solid understanding of the Prior Authorization process for all major insurance payors.
• Reports pertinent, concise information concerning insurance eligibility.
• Monitors all upcoming hospital-based services (Diagnostic Imaging, Surgical Services, etc.) to ensure all authorizations are established.
• Validates these prior authorizations with the payers as necessary.
• Obtains missing prior authorizations.
• Provides complex estimates for procedures as needed.
• Generate Good Faith Estimates for self-pay patients and inform them of their financial obligation.
• Assist underinsured patients by facilitating financial counseling activities and providing resources available to obtain insurance.
• Acts as a resource for complex insurance eligibility, and financial estimations.
• Liaise with patients and insurance payers to resolve complex eligibility issues.
• Explains complex insurance plans in a simple manner to ensure patient understanding.
• Collaborate with internal and external stakeholders to provide knowledge, guidance, and training relating to prior authorization and pre-certification payer requirements and processing.
• Research and monitor payer correspondence (including but not limited to mail, email, newsletters, website information, telephone and fax information) to stay updated on specific payer rules and requirements.
• Monitor, log, and action any denials related to prior authorization and assist with obtaining retroactive authorizations, facilitating appeals, and providing interventions to prevent future denials from occurring.
• Coordinates issues/problems effectively with physician’s office, physician or other hospital department management as needed for problem resolution.
• Maintains high attention to detail by reviewing all work for completeness and accuracy in compliance with organizational quality assurance policies.
• Utilizes department specific knowledge to ask appropriate follow up questions when information is unclear of vague.
• Maintain a clean workspace and waiting area.
• Manages self and resources effectively.
• Acknowledges limits of experience and capability.
• Identifies learning needs and seeks resources.
• Utilizes equipment, systems and supplies appropriately.
• Maintain clean, orderly environment of care.
• Attends at least 50% of monthly staff meetings.
• Performs other duties as assigned.

Benefits

• Generous benefits package, with recognized national carriers, designed to help our people stay healthy, balance work & life responsibilities, protect your assets & plan for a secure financial future.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED