Patient Access Center Representative

Job Description

About the Company

Houston Methodist is a healthcare provider committed to leading in patient care. The job description indicates a focus on providing high-quality service, ensuring financial clearance for patients, and maintaining efficient operations within its Patient Access Center. The organization values critical thinking, customer service, and adherence to protocols like HIPAA and ICARE values.

Job Description: Patient Access Center Representative

This role is a crucial “front door” position within Houston Methodist’s Corporate department, primarily focused on facilitating patient access to services provided by employed and aligned physicians. The representative is responsible for ensuring patients are accurately scheduled, registered, and financially cleared *before• their appointments.

Key Responsibilities:

• Patient Scheduling & Registration:
• Schedules and registers patients for primary and specialty care services using computerized systems.
• Accommodates special requests using independent judgment and critical thinking.
• Obtains required patient data, including demographics, insurance, guarantor, and clinical information.
• Enrolls patients in the Patient Portal and provides PIN numbers, ensuring HIPAA compliance.
• Manages multiple software applications simultaneously for scheduling and registration.
• Assists with urgent referrals from e-fax, emails, and direct doctor’s office calls for same-day/24-hour appointments.
• Financial Clearance & Verification:
• Verifies patient eligibility and benefits.
• Pre-certifies with insurance companies when necessary.
• Works with the revenue cycle team to ensure accurate financial information and registration.
• Identifies and documents potential issues that could lead to service delays or reimbursement denials.
• Monitors and notifies management of opportunities for improvement in financial processes.
• Customer Service & Communication:
• Serves as the primary point of contact for new and established patients, providing information and guidance.
• Utilizes courteous and professional telephone and interpersonal skills, adhering to departmental scripting and ICARE values.
• Triages calls as appropriate and provides information for appointment preparation.
• Maintains open communication with patients, physicians, and service areas regarding actions and resolutions.
• Acts as a liaison between patients and physicians, addressing referral issues with empathy and strong communication skills.
• Handles calls from physicians’ offices, ensuring good relationships and collection of necessary documents for referrals.
• Quality & Safety:
• Adheres strictly to HIPAA guidelines.
• Maintains productivity standards (e.g., abandonment rate, productivity per hour).
• Utilizes resources for insurance verification and eligibility.
• Assists management with auditing/quality review for scheduling and registration accuracy.
• Process Improvement & Growth:
• Provides innovative suggestions for process improvement.
• Identifies areas of concern and improvement for the team and practice to optimize revenue collection.
• Works with management to improve areas requiring concern and strives for excellence.
• Answers calls in a timely manner.

Required Qualifications:

• Education: High School diploma or equivalent.
• Experience: Three years of experience in a healthcare setting, call center, or customer service operations. Alternatively, successful completion of a one-year Houston Methodist Call Center Apprenticeship.
• Skills & Abilities:
• Critical thinking and healthcare knowledge for scheduling processes.
• Excellent communication (written, verbal, telephone) and interpersonal skills.
• Proficiency in medical terminology (diagnoses, operative procedures, CPT codes).
• Strong spelling and grammar skills.
• Working knowledge of PC environment, Windows, word processing, basic Excel, and data entry via keyboard.
• Ability to navigate multiple applications and websites simultaneously.
• Managed care knowledge, differentiating between insurance plans (PPO, POS, HMO).
• Proficiency in English for safety and communication.

Preferred Qualifications:

• Experience: Healthcare setting knowledge with a strong understanding of medical terminology.
• Licenses/Certifications: Certified Medical Assistant (CMA) or Licensed Vocational Nurse (LVN) with satisfactory program completion and clinical licensure.

Work Environment & Additional Information:

• Work Attire: Business professional.
• On-Call: Employees may be required to be on-call during emergencies (e.g., disaster, severe weather events) regardless of selection, and general on-call duty may be required.
• Travel: May require travel within the Houston Metropolitan area.

This role is integral to Houston Methodist’s patient flow and financial health, demanding a blend of technical proficiency, strong customer service, and proactive problem-solving.