Patient Access Representative - Claremore Clinic

Cherokee Nation•Claremore, OK

18h•Onsite

About The Position

The Patient Access Representative collects patient and insurance information, verifies coverage and eligibility, maintains accurate electronic health records, and obtains required consent, privacy, and authorization forms. The representative schedules, cancels, and reschedules appointments for the assigned clinic or department and provides professional customer service to patients, visitors, and callers. The role also supports referrals and service authorizations, insurance coordination, records management, and the day-to-day operation of patient access functions.

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 with whole numbers, common 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 diagrammed instructions and solve problems involving several concrete variables in standardized situations.
Ability to perform the essential duties satisfactorily, with reasonable accommodations available for individuals with disabilities.

Nice To Haves

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

Responsibilities

Greet and assist patients and visitors in person and by phone, address general problems or complaints, make appointment reminder calls, and route calls or take complete messages.
Determine eligibility for patients who have not previously received care within Cherokee Nation Health System by obtaining a CBID card or other proof of tribal membership in a federally recognized tribe.
Help patients complete new or updated forms and obtain required signatures, including 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 and payers.
Scan third-party health cards and explain why the facility bills for services rendered.
Maintain and apply knowledge of the Privacy Act, HIPAA, and other applicable patient confidentiality rules and regulations.
Enter Medicare, Medicaid, and private or commercial insurance information into the electronic records system.
Review notes and communicate with Patient Benefits Advocates or Coordinators to exchange billing information and coordinate patient eligibility and benefits.
Schedule, cancel, and reschedule appointments; make appropriate designations in scheduling queues; and ensure appointments are scheduled promptly.
Use appointment reminder applications and reports, and ensure appointment slots have the time allotments defined by medical staff.
Send clinic or department correspondence to patients.
Maintain acceptable production and quality assurance standards and serve as a primary point of contact for patients.
Use computerized programs and databases to enter, modify, and retrieve sensitive information in electronic health record, scheduling, registration, and reporting systems.
Monitor scheduling queues and wait lists to ensure referrals are handled appropriately and promptly.
Assess patient status and obtain authorization for hospitalization and outpatient services before services are rendered.
Provide retro 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 based on medical personnel recommendations.
Communicate politely and effectively with patients when rescheduling appointments.
Complete daily productivity log forms and direct patient inquiries to appropriate personnel.
Verify 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 and operate copiers, fax machines, and other office equipment.
Assist with and train other or new team members.
Follow call-in procedures established by the supervisor.