Patient Access Representative

DRISCOLL HEALTH PLAN•Corpus Christi, TX

1d•Onsite

About The Position

This position reports to the Central Patient Access Supervisor and is responsible for support functions vital to the service department at various Driscoll Health System facilities. Key responsibilities include referral creation, insurance verification, authorization procurement, pre-service patient contact, and documentation for out-of-pocket expenses. The role requires appropriate age-specific communication skills, safety practices when interacting with customers, patients, and families, and meticulous attention to detail due to the complexity of handling multiple specialties across numerous locations. These locations include Driscoll Children’s Hospital – Main Campus, Driscoll Children’s Hospital – RGV, and CPSST locations in Laredo, McAllen, Brownsville, Pleasanton, Victoria, Harlingen, and Corpus Christi. The individual must maintain utmost confidentiality, adhere to hospital policies and procedures, demonstrate ethical business practices, and comply with corporate compliance, integrity guidelines, customer service standards, and dress code. Driscoll Children’s Hospital is a 191-bed tertiary care center offering 32 medical and 13 surgical specialties, serving 31 South Texas counties. The Driscoll Health System values Compassion, Advocacy, Respect, Excellence, and Stewardship.

Requirements

High school diploma or general education degree (GED); or one to three months related experience and/or training; or equivalent combination of education and experience
Attention to detail is required due to the complex nature of handling multiple specialties at multiple facility locations

Responsibilities

Maintains utmost level of confidentiality at all times
Adheres to hospital policies and procedures
Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines
Adheres and complies with customer service standards and dress code as set forth by the hospital and the department
Answers the department telephone immediately or within three rings utilizing courtesy and patience
Listens to customer needs and takes appropriate action as indicated
Respond to urgent emails and voicemails promptly
Gather patient demographic and financial information in a kind and courteous manner
Document telephone encounters
Call patients to confirm appointment times and offer any other pertinent information such as out of pocket expense, education, directions, parking information, etc.
Conduct warm transfers as needed
Respond to urgent emails and voicemails promptly, and respond to non-urgent emails and voicemails at the end of the day
Place outbound calls to referring providers or guardians (for self-referrals) to obtain missing and validate existing information based on treatment location
Facilitate referral intake based on treatment location
Attempt to reach patient guardian to communicate any pre-visit instructions as necessary
Complete any additional ancillary tasks
Accurately create patient encounter in patient accounting systems utilizing the appropriate patient search criteria and interview method
Verify patient’s insurance benefit and document findings, this process should be completed in the appropriate timeframe for the service being provided
Refer cases for financial screening as indicated
Complete all authorization procurement work functions as indicated
Accurately collect and enter patient demographics into patient accounting systems as indicated
Populate referral data elements into Epic Referral Record as indicated
Complete all pre-service work functions on items in the Epic work queues in accordance with defined policies and procedures
Complete documentation in Epic according to Driscoll Health System and department documentation guidelines
Collect, submit and file documents as appropriate
Review schedule/pre-registrations/registrations to identify potential duplicate medical record numbers
Update data discrepancies in Epic
Identify patients with multiple same day visits to match demographic and insurance data for each pre-registration
Review patient demographic and financial data to ensure accuracy
Validate verification and documentation of insurance eligibility and coverage for anticipated procedures
Validate insurance authorizations was obtained from referring physicians and payors when necessary/appropriate
Reviews pre-registration list for cancellations and notify department as indicated
Identify patients that are missing any pre-registration items
Check for referral minimum data set elements
Review documented notes for payment requirements; explains insurance benefits as quoted to us by their insurance carrier, and collects patient’s out of pocket expenses
Determine if patient is responsible for any payment of service and document how payment is calculated and received
Refer cases for financial screening as indicated
Prepare hospital receipt for payment received
Validates address and phone number
Ensure all paperwork is complete and all documents are correctly filed or attached to patients record
Cash box will be in balance at all times
Payments received will be receipted and accounted for at all times