Patient Access Representative

Job Summary

The Patient Access Representative is responsible for collecting patient information, obtaining current insurance information, and verifying insurance coverage. This position creates and maintains accurate electronic health records and gathers consent, privacy, and authorization forms. The Patient Access Representative is responsible for scheduling, canceling, and rescheduling patient appointments for their respective clinic/department. The person in this position should demonstrate excellent customer service skills and help to resolve patient issues in a prompt, professional manner.

Greets and assists all patients and visitors in a courteous and friendly manner in person, or via phone; assists them with general problems or complaints; makes patient appointment reminder phone calls; refers calls or takes accurate and complete messages. Determines the eligibility of patients seeking healthcare, who have not been previously treated within Cherokee Nation Health System, by obtaining a Certification of Degree of Indian Blood (CBID) card or other documentary proof of tribal membership in a federally recognized tribe.

Assists patients in completing new or updated forms and gathers patient signatures as required. This includes inpatient, outpatient, emergency and after‑hours patients. Interviews all new and existing patients to obtain pertinent registration information necessary to ensure proper healthcare standards. For pre‑registration purposes, this would be done via phone. Verifies patient billing information through automated processes, registration interfaces, patient contact and payer contact by phone as necessary.

For pre‑registration purposes, this would be done via phone. Scans all third‑party health cards and explains to patients why it is necessary for the facility to bill for services rendered. Maintains current knowledge and implements the Privacy Act, Health Insurance Portability and Accountability Act (HIPPA), and other applicable patient confidentiality rules and regulations. Enters Medicare, Medicaid, and private/commercial insurance (i.e. medical, pharmacy, dental, behavioral health, vision, etc.)

into electronic records system. Reviews notes and communicates with the Patient Benefits Advocate/Patient Benefits Coordinator to exchange billing information and to ensure coordination of patient eligibility and benefits. Schedules, cancels, and reschedules patient appointments; makes other appropriate designations and their scheduling queues to ensure all patient appointments are scheduled in a timely manner. Works daily with the automated appointment reminder application and reports.

Ensures patient appointment slots have the appropriate time allotment, as defined by medical staff. Sends out letters of correspondence from the clinic/department to patients. Maintains acceptable production and quality assurance standards. Serves as the front line of contact for the patients. Must operate computerized programs and databases in order to enter, modify, and retrieve sensitive information/data into or from the electronic health record application(s);

i.e. scheduling systems, registration systems, and reporting systems. Monitors scheduling queues/wait lists to ensure that patient referrals are handled appropriately and timely. Assesses patient status, obtains authorization of hospitalization and outpatient services prior to the services being rendered. Provides retro reviews and appeals to insurance companies as needed. Answers calls from insurance companies, physician offices, hospitals, and patients using exemplary customer service.

Documents pre‑certification numbers as needed in the electronic health records applications and designated areas so that the information is easily accessible to other departments. Coordinates and works with providers, case management, insurance carriers, patient access billing, and the patient in securing authorization(s)/payment(s) or service(s) provided. Expedites referrals that are emergency‑based on medical personnel's recommendations. Communicates effectively and politely with patients when rescheduling appointments.

Completes daily…