Sr Patient Access Center Representative - Central Scheduling Primary Care Group (Katy)

At Houston Methodist, the Senior Patient Access Center Representative position is responsible for assuring that patients referred between employed and aligned physicians are scheduled for 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 will be 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 visit our clinics and providing notification to patients, physicians and management of issues that may result in potential service delays or reimbursement denials.

Requirements:

PEOPLE ESSENTIAL FUNCTIONS

• Uses independent judgment and healthcare knowledge to adjust clinic and physicians' schedules and accommodate special requests from internal and external customers as indicated.

• Works with the physician templates and clinical protocols directly as indicated by management and physicians on an as needed basis. Leverages supervisor level access to Provider Match and Epic Gatekeeper access.

• Serves as a liaison for agents, clinic staff and leadership and interacts with all levels of staff and management, physicians, patients and families to obtain information and properly schedule and register 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 appointment per Center/Service protocol. 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 override access and DAR management. Leverages subject matter expertise for Epic with ability to override appointment templates when necessary. Develops departmental scripting and holds others accountable to following appointment scheduling policies by ensuring 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.

• Acts as liaison between the patient and the physician and 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.

• 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.

• Maintains internal controls for ensuring verification and eligibility is met and established correctly prior to patient visit. Provides patients with information needed to prepare for appointment per Center/Service protocol.

• Meets scheduling goals 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 the clinic. Identifies areas of concern and improvement to better the team and the overall practice in collecting revenue from front end operations opportunities. 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.

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.

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

WORK EXPERIENCE

• Five years of experience in healthcare setting/call center operations

• Clinical knowledge and experience with a strong understanding of medical terminology preferred

LICENSES AND CERTIFICATIONS - REQUIRED

• N/A

LICENSES AND CERTIFICATIONS - PREFERRED

• RMA - Registered Medical Assistant (AMT) OR
• LVN - Licensed Vocational Nurse - State Licensure

KNOWLEDGE, SKILLS, AND ABILITIES

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going 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

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* Yes

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

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