Patient Access Specialist

The Patient Access Specialist provides telephone reception and appointing services for the patient in accordance with regional policies and procedures. They work directly under the supervision of the Manager and in collaboration with the Health Care Team. Staff members in this position may perform all or a combination of the duties described depending upon their assigned work area and the specific needs of the department.

Essential Functions:
- Appointing: Review medical chart to appoint according to scripts and guidelines.
- Schedule/reschedule/cancel appointments for services, according to scripts and guidelines.
- Places calls for appointment reminders and quality measure outreach.
- Collect care specific information for Primary Care or Specialty Care services.
- Messaging: Review medical chart to collect information for messages to send to health care team.
- Routes incoming calls from patients, physicians, nurses and other departments according to scripts and guidelines.
- Answers routine administrative inquires.
- Forwards medical and other complex inquires to appropriate personnel.
- Take messages as necessary.
- Manage electronic in-basket in multiple system applications.
- General Services: Assist patients by providing phone numbers, facility directions and office layouts; directing to other departments and administrative services for further information, for example (but not limited to) Membership Services, Dental and Pharmacy.
- Handle ingoing and outgoing departmental mail and correspondence with patients.
- Other related duties as developed per department need.
- Registration: Verify insurance eligibility and/or update all demographic information per regional policies, including Personal Provider Selection, Language Preference and Special Needs.
- Request and/or obtain a patient medical record number when necessary.
- Verify health insurance coverage and follow appropriate policy/procedure.
- Explain co-pays, cost shares and any other applicable fees.
- Create Guarantor accounts as necessary before and after Membership Service Department hours.
- Complete Scheduling form with above data and transfer to the Registration for completion of the pre-registration and pre-verification functions.
- Refers to the financial counselor as appropriate.
- Collect past due balances as appropriate.
- Practice Organization: Coordinate referrals process including wait lists per department policies and procedures.
- Track referrals to specialty care by utilizing the consultation/referral system as needed in those areas where this responsibility currently exists for the individual in this classification.
- Request copies of films, CD's, test reports, and results from outside facilities.
- Coordinate schedules per department guidelines to maximize access.
- Collect and organize data per department guidelines.
- For example, researching and collating data from Health Connect, online quality and performance reports, MOV data, and other sources, on an ongoing basis.
- Develop and submit ongoing reports as requested including statistics, charts, and graphs using multiple computer programs and business math skills.
- Update departmental policies and forms.