Patient Access Center Representative-Referral Management- Katy

JOB SUMMARY

At Houston Methodist, the Patient Access Center Representative position is responsible for assuring that patients referred between employed and aligned physicians 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 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 include providing excellent customer service when communicating with patients who visit our clinics and providing notification to patients, physicians and management of issues that may result in potential service delays or reimbursement denials.

PRIMARY JOB RESPONSIBILITIES

Job responsibilities labeled EF capture those duties that are essential functions of the job.

PEOPLE - 30%

1. Demonstrates ability to use critical thinking skills and healthcare knowledge to manage through primary care and specialty care scheduling processes. Utilizes independent judgement to accommodate special requests from internal and external customers as indicated. (EF)
2. Serves as the front door of the Physician Organization interacting with new and established patients providing them with information needed to schedule and register multiple services for the Physician Organization. Utilizes computerized scheduling/registration systems, verification systems, and online applications while balancing departmental resources. Obtains required data in order to support departmental and hospital clinical/financial needs. (EF)
3. 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 appointment per Center/Service protocol. Enrolls patients on the Patient Portal and provides PIN numbers, complying with HIPAA regulations. (EF)
4. Follows clinical protocols directly as indicated by Kyruss Provider Match, management, and physicians on an as needed basis and consistently manages multiple software applications to schedule appointments. (EF)
5. 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 - 30%

1. Utilizes courteous and professional telephone techniques and interpersonal skills to establish and maintain rapport with patients, physicians/office personnel and various hospital personnel, while maintaining patient confidentiality. Appropriately utilizes ACD/CISCO telephone system. Uses department scripting and appointment scheduling policy when scheduling appointments and ensures I CARE values are met while working within the scripting provided. Assists with new referral from E-fax and emails along with specific doctor’s offices calling directly to schedule emergency patients same day or within 24 hours. (EF)
2. Coordinates the flow of patient referrals: (EF)
   1. Collects and compiles data/information from patients such as insurance documentation and patient identification information to help facilitate an appointment with a SPG/PCG provider.
   2. Screens and assesses patient calls received and assures that the patients are scheduled for services as requested by referring physician.
   3. Schedules patient appointments.
   4. Verifies patient benefits for eligibility.
   5. Efficiently completes registration.
   6. Pre-certifies with insurance companies if necessary.
   7. Answers incoming calls from patients regarding the status of their referrals progress.
   8. Acts as liaison between the patient and the physician.
   9. Handles calls from physicians’ offices, always making sure to maintain a good relationship and obtain all necessary documents needed to support the referral process and close out referral process.
3. Helps facilitate, coordinate and resolve referral issues with patients by exhibiting and exercising exceptional telephone, verbal, written, exemplary critical thinking and interpersonal communication skills. Provides empathetic patient care by focusing on maintaining friendly, and incredibly dynamic environment.

QUALITY/SAFETY - 15%

1. Maintains HIPPA Guidelines and provides empathetic patient care by focusing on maintaining I CARE values throughout the interaction. (EF)
2. Maintains standard of productivity set by department policy and procedures and meets scheduling goals set by the department (e.g. abandonment rate, productivity per hour, etc.)
3. Utilizes resources to perform verification of patient insurance. Obtains required data in order to support departmental and hospital clinical/financial needs. (EF)
4. Ensures verification and eligibility procedures are followed prior to patient visit. Provides patients with information needed to prepare for appointment per Center/Service protocol. Enrolls patients on the Patient Portal and provides PIN numbers, complying with HIPAA regulations.

FINANCE - 20%

1. 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 the clinic. Identifies areas of concern and improvement to better the team and the overall practice in collecting revenue from front end operations being faulty. (EF)
2. 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. (EF)

GROWTH/INNOVATION - 5%

1. Answers calls in a timely manner. Works directly with physicians, office staff and patients to ensure best practices within department. Works with manager to improve areas requiring concern as indicated and strives for excellence in the workplace.

This job description is not intended to be all inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.

EDUCATION REQUIREMENTS

o High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)

EXPERIENCE REQUIREMENTS

o Three years of experience in healthcare setting/call center operations required

o Healthcare setting knowledge and experience with a strong understanding of medical terminology preferred

CERTIFICATIONS, LICENSES AND REGISTRATIONS REQUIRED

o Satisfactory program completion and clinical licensure such as Medical Assistant or Licensed Vocational Nurse preferred

KNOWLEDGE, SKILLS AND ABILITIES REQUIRED

o Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations

o 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

o 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

o Excellent communication and interpersonal skills via telephone and in person

o Demonstrated proficiency in medical terminology to include diagnoses, operative procedures, and CPT codes

o Knowledge of medical terminology and applicability

o Excellent spelling/grammar skills

o Working knowledge of PC environment utilizing Windows and word processing and basic Excel knowledge

o Capable of working and navigating several applications and websites related to registration simultaneously

o Managed care knowledge with the ability to differentiate between insurance plans such as PPO, POS, HMO, etc.

SUPPLEMENTAL REQUIREMENTS

Work Attire Yes/No

Uniform No

Scrubs No

Business professional Yes

Other (dept approved) No

On-Call* Yes, on a limited basis (for Exempt jobs only)

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

Travel**

May require travel within Yes

Houston Metropolitan area

May require travel outside No

of Houston Metropolitan area

**Travel specifications may vary by department.