Patient Access Representative - TRHC

Cherokee Nation•Muskogee, OK

About The Position

The Patient Access Representative at Three Rivers Health Clinic collects patient and insurance information, verifies coverage and eligibility, and creates and maintains accurate electronic health records. The role gathers patient consent, privacy, and authorization forms, and schedules, cancels, and reschedules appointments. It serves as a primary point of contact for patients and visitors, providing courteous assistance and helping resolve issues promptly and professionally. The representative performs patient registration and pre-registration, verifies billing and insurance details, secures service authorizations, coordinates referrals, and communicates with patients, providers, insurers, and other departments. The position also maintains records and scheduling queues, supports clinic correspondence and office operations, and assists with training team members.

Requirements

High school diploma or GED, or at least six months of specialized training, education, or experience.
At least six months of experience in a related field.
Ability to read and comprehend simple instructions, short correspondence, and memos; write simple correspondence; and present information effectively in one-on-one and small-group situations.
Ability to perform arithmetic using whole numbers, fractions, and decimals; compute rates, ratios, and percentages; and interpret bar graphs.
Knowledge of database software.
Ability to use common-sense understanding to follow written, oral, or diagrammatic instructions and solve problems involving several concrete variables in standardized situations.
Ability to perform the essential duties satisfactorily; reasonable accommodations may be made for individuals with disabilities.

Nice To Haves

Experience with Medicaid, Medicare, and third-party billing and guidelines.

Responsibilities

Greet and assist patients and visitors courteously in person and by phone; respond to general problems or complaints, make appointment reminder calls, and refer calls or take accurate messages.
Determine eligibility for patients new to Cherokee Nation Health System by obtaining a Certification of Degree of Indian Blood card or other documentary proof of tribal membership in a federally recognized tribe.
Help patients complete new or updated forms and obtain required signatures for inpatient, outpatient, emergency, and after-hours services.
Interview new and existing patients to collect registration information, including by phone for pre-registration.
Verify patient billing information through automated processes, registration interfaces, and contact with patients or payers.
Scan third-party health cards and explain the need for the facility to bill for services rendered.
Maintain knowledge of and comply with the Privacy Act, HIPAA, and other applicable patient confidentiality requirements.
Enter Medicare, Medicaid, and private or commercial insurance information into electronic records systems.
Review notes and communicate with Patient Benefits Advocates or Coordinators to exchange billing information and coordinate eligibility and benefits.
Schedule, cancel, and reschedule appointments; maintain scheduling designations and queues to support timely scheduling.
Use the automated appointment reminder application and reports daily.
Ensure appointment slots have time allotments appropriate to medical staff direction.
Send clinic or department correspondence to patients.
Meet acceptable production and quality assurance standards and complete daily productivity log forms.
Serve as a front-line contact for patients and direct inquiries to appropriate personnel, including medical staff.
Use computerized programs and databases to enter, modify, and retrieve sensitive information in electronic health record, scheduling, registration, and reporting applications.
Monitor scheduling queues and wait lists so referrals are handled appropriately and promptly.
Assess patient status and obtain authorization for hospitalization and outpatient services before services are rendered.
Provide retroactive reviews and appeals to insurance companies as needed.
Answer calls from insurance companies, physician offices, hospitals, and patients with exemplary customer service.
Document pre-certification numbers in electronic health record applications and designated locations for access by other departments.
Coordinate with providers, case management, insurance carriers, patient access billing, and patients to secure authorizations, payments, or services.
Expedite emergency-based referrals when recommended by medical personnel.
Communicate politely and effectively with patients when rescheduling appointments.
Verify patient demographic, insurance, emergency contact, and eligibility information for accuracy and completeness.
File and retrieve applications and records, research missing records, tabulate data, and assemble or repair records and files according to established procedures.
Order and issue supplies as appropriate.
Operate copiers, fax machines, and other office equipment.
Assist and train other or new team members.
Follow supervisor-established call-in procedures.