Sr Patient Access Center Representative Referral Management

At Houston Methodist, the Senior Patient Access Center Representative position is responsible for assuring that patients in need of scheduling appointments are scheduled to receive services in their assigned location and are financially cleared prior to their scheduled appointment through accurate and timely scheduling, registration, and verification of eligibility and benefits. This position is responsible for executing complex processes related to scheduling or other department-related protocols. The Senior Patient Access Center Representative position assists management with ongoing observations and notifications of opportunities while providing innovative suggestions for process improvement. This position also assists management with auditing/quality review to ensure accurate and appropriate scheduling and registration. Additional responsibilities for the Senior Patient Access Center Representative position include providing excellent customer service when communicating with patients who receive services at our facilities and providing notification to patients, physicians, hospital/clinical staff, and management of issues that may result in potential service delays or reimbursement denials.

FLSA STATUS
Non-exempt

QUALIFICATIONS

EDUCATION

• High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)
• Associate’s degree preferred

EXPERIENCE

• Four years of experience in healthcare setting/call center operations
• Healthcare setting knowledge and experience with a strong understanding of medical terminology preferred

SKILLS AND ABILITIES

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through ongoing skills, competency assessments, and performance evaluations
• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
• Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
• Ability to multitask, prioritize and the flexibility to meet the needs of the department
• Excellent communication and interpersonal skills via telephone and in person
• Demonstrated proficiency in medical terminology to include diagnoses, operative procedures, and CPT codes
• Ability to remain calm and patient in stressful situations
• Excellent spelling/grammar skills
• Working knowledge of PC environment utilizing Windows and word processing; basic Excel, Word and PowerPoint knowledge
• Capable of working and navigating several applications and websites related to registration simultaneously
• Managed care knowledge with the ability to differentiate between insurance plans such as PPO, POS, HMO, etc.
• Strong training, coaching to performance and leadership skills

ESSENTIAL FUNCTIONS

PEOPLE ESSENTIAL FUNCTIONS

• Demonstrates the ability to use critical thinking skills and healthcare knowledge to manage through primary care, specialty care, and ancillary scheduling processes. Utilizes independent judgment to accommodate special requests from internal and external customers as indicated.
• Follows established protocols directly as indicated by management and physicians on applicable platforms on an as needed basis and consistently manages multiple software applications to schedule appointments.
• Serves as a liaison for agents, hospital/clinical staff, and leaders and as such will interact with all levels of staff and management, physicians, patients and families to obtain information and properly schedule and register patients for services.
• Serves as a role model and mentor to less experienced staff. Provides feedback to peers to effectively change behavior. Motivates and inspires peers to impact a change in culture.
• Triages calls for the Patient Access Center as appropriate to other areas as received on a daily basis while working under the guidelines and scripts as set forth by management. Provides patients with information needed to prepare for appointments per Center/Service protocols. Enrolls patients on the Patient Portal and provides PIN numbers, complying with HIPAA regulations.
• Discusses department performance metrics and recommendations for performance improvement. Keeps open channels of communication with all parties involved, including physician, patient and service areas, regarding action taken and resolution. Promotes a friendly and professional customer service environment.

SERVICE ESSENTIAL FUNCTIONS

• Handles first-level escalations with patients, leveraging electronic medical record for appointment and/or customer service management. Leverages subject matter expertise for Epic with ability to override appointment templates when necessary. May develop departmental scripting and demonstrates excellence by following appointment scheduling policies and ensuring I CARE values are met while working within the scripting provided. Demonstrates knowledge and understanding of the various workflows of the Access Center Agents and is able to train new or newly transferred agents.
• Acts as liaison between the patient and the physician and handles calls from physicians’ office, always making sure to maintain a good relationship and obtain all necessary documents needed to support the referral process and close out referral process.
• Displays initiative to improve job functions, offers suggestions to streamline process for efficient patient flow and other quality or service matters. Conducts workflow assessments with schedulers to improve department performance.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• Utilizes resources to perform verification of patient insurance. Obtains required data in order to support departmental and hospital clinical/financial needs. Maintains standard of productivity set by department policy and procedures. Uses established auditing procedures to process appointments and registrations.
• Follows internal controls to ensure accurate appointing and assignment of valid insurance and eligibility is established correctly prior to patient visit. Provides patients with information needed to prepare for appointment per Center/Service protocol.
• Meets scheduling goals and maintains standards of productivity set by the department (e.g., abandonment rate, productivity per hour, etc.)

FINANCE ESSENTIAL FUNCTIONS

• Works directly with the revenue cycle team and other departments to ensure the correct information and registration is complete and accurate prior to the patient visiting Houston Methodist for services. Identifies cost savings and other opportunities for efficiencies.
• Obtains and enters accurate scheduling and registration data, including but not limited to: patient demographics, insurance, guarantor and clinical information on the information system in order to initiate financial clearance activities (benefit eligibility and verification, pre-certification notification and payment review). Documents patient’s accounts with information related to any potential issue(s) that could result in service delays or cancellations due to the lack of financial clearance.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

• Seeks opportunities to expand learning beyond baseline competencies with a focus on continual development. Keeps informed of system changes and influences others to incorporate changes in a timely and accurate manner.

SUPPLEMENTAL REQUIREMENTS
WORK ATTIRE

• Uniform: No
• Scrubs: No
• Business professional: Yes
• Other (department approved): No

ON-CALL*
*Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Events, etc) regardless of selection below.

• On Call* No

TRAVEL**
**Travel specifications may vary by department**

• May require travel within the Houston Metropolitan area Yes
• May require travel outside Houston Metropolitan area No