Patient Access Representative-Cherokee Nation Outpatient Health Center

Cherokee Nation•Tahlequah, OK

2d•Onsite

About The Position

The Patient Access Representative works at the Cherokee Nation Outpatient Health Center in Tahlequah. This role collects patient and insurance information, verifies insurance coverage and eligibility, maintains accurate electronic health records, and obtains required consent, privacy, and authorization forms. The representative schedules, cancels, and reschedules appointments and provides courteous, professional customer service to patients and visitors. The position also supports registration, referrals, insurance authorization, and coordination of patient benefits. It requires handling sensitive information in accordance with applicable privacy and confidentiality requirements, using electronic health record and scheduling systems, and maintaining required productivity and quality standards. The representative may assist with training new team members and performs related filing, record, supply, and office-equipment tasks.

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 settings.
Ability to perform basic arithmetic using whole numbers, common fractions, and decimals; compute rates, ratios, and percentages; and interpret bar graphs.
Knowledge of database software.
Ability to apply common-sense understanding to written, oral, or diagrammed instructions and address 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, third-party billing, and related guidelines is preferred.

Responsibilities

Greet and assist patients and visitors in person and by phone; respond to general problems or complaints, make appointment reminder calls, and route calls or take accurate messages.
Determine eligibility for patients who have not previously received care within Cherokee Nation Health System by obtaining a Certification of Degree of Indian Blood (CBID) card or other proof of 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 patients.
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 insurance cards and explain the need to bill for services rendered.
Maintain knowledge of and follow the Privacy Act, HIPAA, and other applicable patient confidentiality rules and regulations.
Enter Medicare, Medicaid, and private or commercial insurance information into electronic records systems.
Communicate with Patient Benefits Advocates or Patient Benefits Coordinators to exchange billing information and coordinate eligibility and benefits.
Schedule, cancel, and reschedule appointments; maintain scheduling designations and queues so appointments are scheduled in a timely manner.
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.
Meet applicable production and quality assurance standards and serve as a front-line 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 retroactive reviews and appeals to insurance companies as needed.
Answer calls from insurance companies, physician offices, hospitals, and patients while providing exemplary customer service.
Document pre-certification numbers in electronic health records 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 as recommended by medical personnel.
Communicate effectively and politely with patients when rescheduling appointments.
Complete daily logs for productivity calculations and direct patient inquiries to appropriate personnel.
Verify patient demographic, insurance, emergency contact, and eligibility information for accuracy and completeness.
File, retrieve, research, assemble, and repair applications, records, and files according to established procedures; tabulate data as required.
Order and issue supplies as appropriate and operate copier, fax machines, and other office equipment.
Assist and train other or new team members.
Follow call-in procedures established by the supervisor.