Patient Access Center Representative

Job Description

About the Company:
Houston Methodist is a healthcare organization committed to providing patient services. The Patient Access Center operates within their Corporate division, serving as a crucial link between patients, employed, and aligned physicians. The organization emphasizes excellent customer service, financial clearance, efficient scheduling, and adherence to HIPAA guidelines and ICARE values (which are likely core company values). They also focus on continuous process improvement and quality assurance.

Job Description: Patient Access Center Representative

The Patient Access Center Representative at Houston Methodist Corporate is a vital front-line position responsible for ensuring a seamless patient experience from initial referral through financial clearance and scheduling. This role serves as the “front door” for the Physician Organization, interacting extensively with both new and established patients, physicians, and various hospital personnel.

Core Responsibilities:
• Accurate and timely scheduling, registration, and verification of eligibility and benefits for patients referred between employed and aligned physicians.
• Ensuring patients receive services in their assigned location and are financially cleared prior to their scheduled appointment.
• Assisting management with identifying opportunities for process improvement and providing innovative suggestions.
• Conducting auditing/quality review to ensure accurate and appropriate scheduling and registration.
• Providing excellent customer service to patients visiting clinics and communicating with them via phone.
• Notifying patients, physicians, and management of issues that may lead to service delays or reimbursement denials.

Essential Functions Breakdown:

• People Essential Functions:
• Utilizes critical thinking and healthcare knowledge for primary and specialty care scheduling.
• Exercises independent judgment for special requests.
• Serves as the initial point of contact for patients, providing information and managing scheduling/registration via computerized systems and online applications.
• Triage calls, following guidelines and scripts, and providing appointment preparation information.
• Enrolls patients on the Patient Portal and provides PINs, ensuring HIPAA compliance.
• Follows clinical protocols (e.g., Kyruss Provider Match) and consistently manages multiple software applications for scheduling.
• Maintains open communication with all parties (physician, patient, service areas) regarding actions and resolutions, promoting a friendly and professional environment.

• Service Essential Functions:
• Maintains professional and courteous telephone techniques and interpersonal skills, establishing rapport while ensuring patient confidentiality.
• Efficiently uses ACD/CISCO telephone system, adhering to department scripting and appointment scheduling policies, and upholding ICARE values.
• Assists with new referrals from e-fax, emails, and direct calls from doctors’ offices, including emergency same-day/24-hour scheduling.
• Coordinates patient referrals by collecting patient and insurance data, screening calls, scheduling appointments, verifying benefits, and completing registration.
• Performs pre-certification with insurance companies when required.
• Answers patient inquiries regarding referral status and acts as a liaison between patient and physician.
• Handles calls from physicians’ offices, maintaining good relationships and obtaining necessary documents to support and close the referral process.
• Facilitates and resolves referral issues with exceptional telephone, verbal, written, critical thinking, and interpersonal communication skills, providing empathetic patient care.

• Quality/Safety Essential Functions:
• Adheres to HIPAA Guidelines and demonstrates empathetic patient care by consistently applying ICARE values.
• Maintains productivity standards (e.g., abandonment rate, productivity per hour) set by department policies.
• Utilizes resources for patient insurance verification and obtains necessary data for clinical/financial needs.
• Ensures verification and eligibility procedures are followed before patient visits and provides patients with pre-appointment information.

• Finance Essential Functions:
• Collaborates with the revenue cycle team and other departments to ensure accurate and complete information/registration before patient visits.
• Identifies and communicates areas of concern and improvement to enhance revenue collection and address faulty front-end operations.
• Obtains and accurately enters scheduling and registration data (demographics, insurance, guarantor, clinical info) into the system to facilitate financial clearance (benefit eligibility, verification, pre-certification notification, payment review).
• Documents patient accounts with information regarding potential issues that could lead to service delays or cancellations due due to lack of financial clearance.

• Growth/Innovation Essential Functions:
• Answers calls promptly.
• Works directly with physicians, office staff, and patients to implement best practices within the department.
• Collaborates with management to improve areas of concern and strives for excellence.

Education and Experience:
• Education Required: High School diploma or equivalent (GED, homeschool equivalency, partial/full post-secondary education).
• Work Experience Required: Three years of experience in a healthcare setting/call center or customer service operations; OR successful completion of a one-year Houston Methodist Call Center Apprenticeship in lieu of experience.
• Work Experience Preferred: Healthcare setting knowledge and experience with a strong understanding of medical terminology.

Licenses and Certifications:
• Required: N/A
• Preferred: Certified Medical Assistant (CMA) or Licensed Vocational Nurse (LVN) with satisfactory program completion and clinical licensure.

Knowledge, Skills, and Abilities:
• Demonstrated ability to safely perform assigned job through ongoing skills, competency assessments, and performance evaluations.
• Proficiency in speaking, reading, and writing English to perform essential functions, especially regarding patient/employee safety.
• Effective communication skills with patients, physicians, family members, and co-workers, with a customer service focus and positive language.
• Excellent communication and interpersonal skills (telephone and in-person).
• Proficiency in medical terminology including diagnoses, operative procedures, and CPT codes.
• Knowledge of medical terminology and its applicability.
• Excellent spelling/grammar skills.
• Working knowledge of PC environment, Windows, word processing, and basic Excel.
• Ability to enter data via keyboard throughout the work schedule.
• Capable of working with and navigating several applications and websites related to registration simultaneously.
• Managed care knowledge with the ability to differentiate between insurance plans (PPO, POS, HMO, etc.).

Supplemental Requirements:
• Work Attire: Business professional.
• On-Call: Yes (Note: Employees may be required to be on-call during emergencies regardless).
• Travel: May require travel within the Houston Metropolitan area.