Patient Access Representative

Cherokee Nation•Tahlequah, OK

1d•Onsite

About The Position

The Patient Access Representative collects patient information, obtains current insurance information, and verifies insurance coverage. The role creates and maintains accurate electronic health records and gathers consent, privacy, and authorization forms. It also schedules, cancels, and reschedules patient appointments for the assigned clinic or department. The representative provides customer service and helps resolve patient issues promptly and professionally. This position is located at the CN Outpatient Health Center in Tahlequah. The representative serves as a front-line contact for patients, visitors, insurance companies, physician offices, and hospitals. The position uses computerized scheduling, registration, reporting, and electronic health record systems to manage sensitive information and support patient access, eligibility, billing, referrals, and authorizations.

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.
Ability to write simple correspondence and effectively present information in one-on-one and small-group situations to customers, clients, and employees.
Ability to perform arithmetic using whole numbers, common fractions, and decimals; compute rates, ratios, and percentages; and draw and interpret bar graphs.
Knowledge of database software.
Ability to apply common-sense understanding to carry out 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 courteously in person and by phone; address general problems or complaints, make appointment reminder calls, and refer calls or take complete messages.
Determine eligibility for healthcare for patients not previously treated within Cherokee Nation Health System by obtaining a CBID card or other documentary proof of tribal membership in a federally recognized tribe.
Assist patients with completing new or updated forms and obtaining required signatures, including for inpatient, outpatient, emergency, and after-hours patients.
Interview new and existing patients to collect registration information; conduct pre-registration interviews by phone when applicable.
Verify patient billing information using automated processes, registration interfaces, and contact with patients and payers, including by phone for pre-registration.
Scan third-party health cards and explain why the facility must bill for services rendered.
Maintain knowledge of and implement 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.
Review notes and communicate with Patient Benefits Advocates or Patient Benefits Coordinators to exchange billing information and coordinate eligibility and benefits.
Schedule, cancel, and reschedule appointments; make appropriate designations in scheduling queues to ensure timely scheduling.
Work daily with the automated appointment reminder application and reports.
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.
Operate computerized programs and databases to enter, modify, and retrieve sensitive data 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 while providing exemplary customer service.
Document pre-certification numbers in the electronic health record applications and designated areas so other departments can access the information.
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 effectively and politely with patients when rescheduling appointments.
Complete daily log forms for productivity calculations.
Use interpersonal and relationship skills to provide exceptional customer service to patients and internal and external coworkers.
Direct patient inquiries to appropriate personnel, such as medical personnel.
Verify patient information for accuracy and completeness, including demographic, insurance, emergency contact, and eligibility information.
File and retrieve applications and records according to established procedures; research lost or missing records, tabulate data, and assemble or repair records and files as necessary.
Order and issue supplies as appropriate.
Operate copiers, fax machines, and other office equipment.
Assist and train other or new team members.
Follow call-in procedures established by the supervisor.