Patient Access Team Specialist

DME Service Solutions; Taguig; On-site; PHP 279,000 - 502,000; Full time

Job summary

DME Service Solutions in the Philippines is seeking a Patient Access professional to support the PAT Services and scheduling workflows. You will screen patients, verify eligibility, and schedule appointments using EPIC (OCHIN) following templates and provider schedules.

You will ensure lab results are reviewed, assist with Sliding Fee Discount criteria, complete documentation in EMR, and maintain HIPAA compliance while delivering courteous service in a fast-paced environment.

Qualifications

• Hands-on EPIC experience, preferably OCHIN.
• Prior patient scheduling or clinical front office experience.
• Inbound calls in a high-volume environment.

Responsibilities

• Conduct patient screening to identify service needs, referral requirements, and appropriate care pathways.
• Verify patient eligibility for services, insurance coverage, payer requirements, PCP assignments, IPA affiliations, and authorization needs.
• Schedule patient appointments directly in EPIC (OCHIN) following established templates, provider schedules, routing rules, clinical restrictions, and specialty-specific workflows.
• Verify and review laboratory results as required to ensure patients meet appointment, treatment, or program requirements prior to scheduling or care delivery.
• Screen patients for eligibility under the Sliding Fee Discount Program and document outcomes in accordance with organizational policies and regulatory requirements.
• Perform appointment readiness verification by confirming required documentation, referrals, authorizations, insurance eligibility, laboratory results, and other visit prerequisites.
• Provide care pathway navigation and patient education, helping patients understand available services, appointment requirements, referral processes, and next steps in their care journey.

Skills

Patient scheduling

Call center operations

Inbound calls

Critical thinking

Tools

EPIC (OCHIN)

Job description

Key Responsibilities

Patient Access Team (PAT) Services

• Conduct patient screening to identify service needs, referral requirements, and appropriate care pathways.
• Verify patient eligibility for services, insurance coverage, payer requirements, PCP assignments, IPA affiliations, and authorization needs.
• Schedule patient appointments directly in EPIC (OCHIN) following established templates, provider schedules, routing rules, clinical restrictions, and specialty-specific workflows.
• Verify and review laboratory results as required to ensure patients meet appointment, treatment, or program requirements prior to scheduling or care delivery.
• Screen patients for eligibility under the Sliding Fee Discount Program and document outcomes in accordance with organizational policies and regulatory requirements.
• Perform appointment readiness verification by confirming required documentation, referrals, authorizations, insurance eligibility, laboratory results, and other visit prerequisites.
• Provide care pathway navigation and patient education, helping patients understand available services, appointment requirements, referral processes, and next steps in their care journey.

Patient Scheduling & Intake

• Schedule patient appointments directly in EPIC (OCHIN) following established templates, routing rules, provider schedules, and clinical restrictions.
• Complete full patient intake, including validation of demographics, PCP/IPA assignment, and referral requirements.
• Follow appointment scheduling workflows, including specialty-specific requirements and visit-type rules.

Insurance Eligibility & Coverage Verification

• Verify patient insurance eligibility, coverage details, and plan requirements at the time of the call using approved systems and EPIC tools.
• Confirm PCP assignments, IPA affiliations, and authorization needs based on payer rules.
• Follow all eligibility verification workflows to ensure accurate and compliant patient scheduling.

Call Handling & Customer Support

• Handle high-volume inbound calls; outbound and conference calls may also be required.
• Meet and maintain performance metrics including:
  • 100+ calls per day (inbound, outbound, and conference combined).
  • Average Handle Time (AHT): 5 minutes.
• Use approved scripts, call flows, and routing protocols to ensure consistent and compliant patient interactions.
• Provide clear, courteous, and professional communication throughout every patient engagement.

Documentation & Chart Completion

• Document call details, actions taken, and patient interactions accurately in EPIC.
• Ensure complete chart closure and proper handoff to downstream teams.
• Maintain accuracy and completeness of patient records in compliance with organizational policies.

Compliance, Security & Training

• Maintain strict adherence to HIPAA, data privacy standards, and role-based system access rules.
• Participate in all required training, including EMR proficiency, eligibility workflows, call handling, and compliance modules.
• Follow internal quality, security, and regulatory policies at all times.

Required Skills & Qualifications

Experience

• Required: Hands-on experience using EPIC (preferably OCHIN environment).
• Required: Previous experience in patient scheduling, medical call center operations, or clinical front office support.
• Required: Inbound call experience in a high-volume environment.
• Experience with insurance eligibility, medical terminology, and payer workflow processes is preferred.

Skills

• Strong navigation and multitasking skills within EMR and payer systems.
• Excellent critical thinking and analytical skills for interpreting eligibility details and resolving scheduling challenges.
• Strong verbal communication and service-oriented professionalism.
• Ability to follow structured workflows, scripting, and routing requirements with accuracy.
• Fast learner with strong attention to detail, reliability, and follow-through.

Other Requirements

• Ability to work in an onsite set-up as required by business operations.
• Ability to maintain productivity and quality in a fast-paced, high-volume patient access environment.

Process Workflow (Based on Provided Diagram)

The role includes responsibilities across the full patient scheduling cycle:

1. Start
2. Patient Intake & Verification
3. Insurance Eligibility & PCP/IPA Validation
4. Appointment Scheduling & Restrictions
5. Financial Screening & Authorization (as applicable)
6. Documentation & Chart Closure
7. End