Patient Access Representative

Job Summary and Responsibilities

As a Patient Access Representative, you will manage administrative duties for the patient intake process in our clinic, adhering to established guidelines.Every day you will interact with patients in person and by phone, facilitating check-in/out, collecting data and payments, validating insurance, scheduling appointments, and processing referrals and authorizations.To be successful, you will demonstrate critical thinking, strong customer service, and knowledge of insurance, billing, and medical terminology, ensuring a seamless, high-quality patient intake experience.

• Registers and/or checks patients in/out.
• Performs patient check-in at the time of visit; records and verifies all demographic, insurance and other information (e.g. Workers’ Comp, other third-party liability info); follows established procedures to ensure that all registration guidelines/requirements have been satisfied, including ensuring minors’ guardians have been notified; identifies deficiencies and resolves non-complex issues or escalates to appropriate staff for further action. Conducts routine insurance eligibility verifications. Copies/scans patient access related hardcopy materials (e.g. ID, referrals, L&I, insurance cards, etc.) into correct location in electronic medical record. Records non-clinical charges from various sources. This could include entering charges for the completion of forms, for Depositions/Attorney Fees, for retail fees, etc. Handles and reconciles payments. Collects appropriate co-payments, co-insurances, and other fees/monies due, including cash payments (in accordance with FMG Business Office Cash Handling Procedures); posts payments to patient accounts.
• Collects payments at the time of check-in or check-out where appropriate. Performs end-of-day payment reconciliation; balances and closes out cash drawers; ensures that outstanding tasks are completed and that preparation work for the next day’s clinic is completed or assigned to other staff. Continually monitors and reconciles issues prior to patient visit. Researches to identify and reconcile remaining issues before patients arrives for their appointment. Makes registration and other front-end corrections. Ensures that all missing/erroneous/incomplete information is updated. Ensures that all insurance eligibility checks are conducted where possible. Resolves edits in the work queues. Processes referral orders and/or pre-authorizations.
• Ensures that insurance eligibility checks have been conducted on all referrals before the patient is seen, either by escalating to the Insurance Verifier, or by directly checking on eligibility. Completes referrals and/or pre-authorization, before the patient is seen, for diagnostic testing, therapy, surgeries, procedures and specialty care according to requirements and patient preference. Provides information to patients regarding their health care plan; interprets and communicates plan policies and procedures to employees, physicians and members (patients). Provides patients with answers to billing and insurance clarification questions; obtains a cost estimate when requested, and explains insurance benefit coverage to patient. Notifies physician(s) and patient when referral is denied or if a second opinion or additional info is needed. Updates the patient’s medical record as necessary. Copies/scans documents into correct location within electronic medical record.
• May interact with referring clinic to ensure successful coordination of patient care. Coordinates appointments and ancillary services. Schedules patients for multiple providers and clinics if assigned to Call Center work unit. Coordinates patient clinic visits based on authorized referral in accordance with established standards and procedures; gathers and documents insurance eligibility data, conducting routine verifications that can be done quickly during conversation; enters data in patient’s electronic medical record as appropriate. Identifies patients requiring contact to confirm a referral appointment; contacts patient in accordance with established procedures. Contacts and follows up with patients to reschedule a missed/cancelled appointment; documents reason(s) for no-show in accordance with established procedures; notifies management if patient has violated a policy and further action is required.
• Makes arrangements for addressing special/ancillary patient requirements, including transportation, interpreters and other needs relating to patient care and satisfaction.

Job Requirements

Required

• One year of customer service work experience and
• None, upon hire

Preferred

• Two years of customer service work experience and
• Healthcare or Call Center experience

Where You’ll Work

Virginia Mason Franciscan Health has a rich history of providing exceptional healthcare, dating back to 1891. Building upon a legacy of compassionate care and innovation, our organization has evolved over the years through strategic partnerships and integrations to expand our reach and services across the Puget Sound area.Today, as Virginia Mason Franciscan Health, we remain deeply committed to healing the whole person – body, mind, and spirit – in the communities we serve. This commitment is strengthened by the diverse expertise and shared values brought together through our growth.Our dedicated providers offer a full spectrum of health care services, from routine wellness to complex disease management, all grounded in rigorous research and education. Our comprehensive network of 10 hospitals and nearly 300 care sites strategically located across the greater Puget Sound region reflects our ongoing commitment to accessibility and comprehensive care.We are proud of our pioneering medical advances and numerous awards and accreditations that reflect our dedication to excellence. When you join Virginia Mason Franciscan Health, you become part of a team that delivers top-quality, professional healthcare in modern, well-equipped facilities, and contributes to a legacy of service built on collaboration and shared purpose.