Patient Service Representative
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The Patient Access Specialist provides convenient access to services for patients and minimizes financial risk to the organization. The Patient Access Specialist will maximize reimbursement by efficiently scheduling and pre-registering patients for their upcoming service at Northwestern Medicine as well as promotes accuracy and timeliness of data processing and maintains customer services objectives. This role includes scheduling the patient, updating insurance and demographic information, performing medical necessity checks as appropriate, verifying the authorization was initiated by the physician’s office, and initiating financial account processes and educating patients regarding policies, procedures, expectations and financial responsibilities.
Provides outstanding and professional Customer Service to all internal and external customers.
- Consistently practices Patients First philosophy and adheres to high standards of customer service. This includes setting an example to peers, coworkers, etc. by fostering a team atmosphere.
- Responds to questions and concerns. Forwards, directs, and notifies Team Lead or Operations Coordinator of extraordinary issues as necessary.
- Maintains patient confidentiality per HIPAA regulations.
- Provides exceptional customer service to patients which establish a positive first impression of Northwestern Medicine. Exceeds all consumer requests and alerts management of issues or concerns that require escalation.
- Correctly identifies and collects patient demographic information in accordance with organization standards.
- Interacts with various hospital departments and physician’s offices to effectively schedule and direct patients through the NMHC systems in a patient/customer friendly manner.
- Reaches out to patients to schedule an appointment as defined.
- Performs medical necessity checks as necessary for scheduled services, communicates options to patient if appointment fails.
- Informs patients of any issues with securing the financial account for their encounter.
- Completes out-of-pocket estimations as requested by patients.
- Provides training and education as needed.
- Manages work schedule efficiently, completing tasks and assignments on time.
- Completes other duties assigned by manager. Cross-training between various departments will take place to ensure coverage.
- Participates in Quality Assurance reviews to ensure integrity of patient data information.
- Uses effective service recovery skills to solve problems or service breakdowns when they occur.
- Utilizes department and hospital policies and procedures to complete assigned tasks.
- Adherence to all department policies and compliance requirements.
- Avoids putting patient in financial or safety risk.
- Other duties as assigned.
Communication and Collaboration
- Communicates information to the patient regarding questions about physician referrals, insurance referrals and consultations. Collects authorization numbers in appropriate systems as applicable.
- Provides professional and constructive environment for communication across units/departments and resolves operational issues. May attend intra/interdepartmental meetings which involve walking within NM Campus.
- Communicates customer satisfaction issues to appropriate individuals.
- Demonstrates teamwork by helping co-workers within and across departments. Communicates effectively with others, respects diverse opinions and styles, and acknowledges the assistance and contributions of others.
- Interacts with internal customers to provide excellent support service to staff in departments which provide direct patient care.
- Accommodates all levels of communication ability.
- Utilizes multiple online order retrieval systems to verify or print the patient’s order.
- Verifies insurance eligibility and benefit levels through the use of online tools (NDAS, ASF, etc.) or over the phone as necessary.
- Completes accurate handoff instructions and notes to scheduling staff, by noting appropriately in Epic.
- Demonstrates ability to use all computer applications efficiently and to the capacity needed in this position.
- Runs real time eligibility (RTE) on all patients to verify insurance and follows out of network policies as applicable.
- Sends quality Epic Messages/Telephone encounters that are descriptive and grammatically correct.
Efficiency, Process Improvement, and Business Growth
- Proactive in preventing issues with patient visit by double checking type of test, preps required, assuring no conflict with other tests, verifying time and location, communicating relevant information, verifying documenting order retrieval in notes for check-in person, ensures there are no duplicate patient records.
- Understands minimum data set required for a complete registration, collects and verifies critical data and updates that information into registration system.
- Understands departmental and individual quality metrics.
- Proactively analyzes account activity, identifies problems, and initiates appropriate actions/resolutions.
- Evaluates procedures and suggests improvements to enhance customer service and operational efficiency.
- Participates in departmental quality improvement activities.
- Provides ideas and suggestions for process improvements within the department.
- Monitors registration and scheduling, including insurance verification to ensure processing within prescribed quality standards.
- Adjusts processes as needed to meet standards.
- Uses organizational and unit/department resources efficiently.
- Acts as a training resource for new staff and a resource for coworkers, sharing process and workflow information.
- Understands that schedule may change to reflect shifting business needs.
- Evolves and learns as healthcare policies change.
- High School diploma or equivalent.
- 2-3 years customer service or medical office experience.
- Excellent interpersonal, verbal, and written communication skills.
- Proficiency in computer data-entry/typing.
- Excellent verbal and written communication skills.
- Ability to read, write, and communicate effectively in English.
- Basic Computer Skills.
- Ability to type 40 wpm.
- Ability to multi-task.
- Customer service oriented.
- Excellent organizational, time management, analytical, and problem solving skills.
- Additional education.
- Additional language skills.
- Healthcare finance and/or healthcare insurance experience.
- Knowledge and experience in a healthcare setting, especially patient scheduling and/or registration.
- Internal: Incumbents in this position communicate with physicians and all levels of employees in Northwestern Medicine
- External: Patients and their families and representatives, physician offices, other health care agencies and health care providers, insurance companies and financial agencies and contracted outside services.