Patient Access Representative

Texas Children's Medical Center•Houston, TX

15d

About The Position

The Patient Access Representative ensures timely and accurate patient registration and serves as a liaison among patients and families, payers, Healthcare Information Management (Medical Records), Patient Financial Services or Business Services, and other healthcare team members. Using a unique medical record number, the representative supports patient tracking and billing by obtaining and verifying complete demographic information, financially securing accounts, and collecting out-of-pocket responsibility from guarantors to maximize hospital reimbursement. The role maintains compliance with EMTALA, The Joint Commission, and other hospital and government regulations applicable to the admissions setting. It also identifies patients who may qualify for government resources or the hospital charity program and refers them to a financial counselor.

Requirements

High school diploma required.
Six months of experience as an admissions representative or counselor performing all aspects of the registration process preferred.
An associate or bachelor's degree may be substituted for the experience.

Nice To Haves

Six months of experience as an admissions representative or counselor performing all aspects of the registration process.
Associate or bachelor's degree as a substitute for the experience.

Responsibilities

Obtain, verify, and enter complete and accurate demographic information on accounts to support processing through the revenue cycle.
Search the patient accounting system for an existing medical record for each visit and use appropriate search techniques to prevent duplicate records in the master patient index.
Enter verified demographic information accurately, including patient name, date of birth, gender, address, phone number, and guarantor data, following hospital naming protocols.
Monitor and work assigned DARs and/or work queues daily, ensuring account elements are secured for billing.
Financially secure patient accounts in a customer-service-oriented manner to maximize hospital reimbursement.
Verify insurance benefits for all plans associated with a patient and confirm the correct payer and plan are entered into EPIC.
Enter patient estimates in estimating software when required.
Obtain insurance referrals as required by individual plans and document referral numbers in the appropriate fields.
Document whether authorization is required and involve the Authorization Specialist when clinical authorization is needed.
Provide estimates of patient liability to patients or guarantors before visits as part of financially securing accounts.
Refer self-pay accounts requiring funding assistance to the financial counseling department.
Pre-register patients 2–10 working days before an appointment or admission to provide customer service.
Register unscheduled patients as soon as notified and obtain insurance benefits and referrals or authorizations before services are provided or before discharge.
Obtain clinical and financial authorization as required by contract for services.
For patients admitted as inpatients from outpatient areas, verify inpatient benefits, notify bed control, and begin the pre-certification process.
Maintain compliance with EMTALA, The Joint Commission, and applicable hospital and government regulations.
Identify patients who may be eligible for government resources or the hospital charity program and refer them to a financial counselor.