Patient Access Representative

Texas Children's Hospital; Houston (TX); On-site; USD 42,000 - 68,000; Full time

Job summary

Texas Children’s Hospital is seeking a Patient Access Representative to ensure timely and accurate patient registration and to act as a liaison between patients, payers, and internal teams. The role focuses on verifying demographics, securing financial responsibility, and maximizing hospital reimbursement within EMTALA and regulatory guidelines.

The incumbent will pre-register patients, verify insurance coverage, obtain referrals/authorizations, and provide cost estimates to patients.

Qualifications

• High School Diploma required.
• 6 months experience as an admissions representative/counselor performing all aspects of the registration process preferred.
• Associate or bachelor’s degree may be substituted for the experience.

Responsibilities

• Obtain, verify, and enter complete demographic information to facilitate billing.
• Search the patient accounting system for existing records to avoid duplicates.
• Enter accurate demographic data including name, DOB, gender, address, and guarantor information.

Skills

Customer service

Attention to detail

Communication

Education

High School Diploma

Associate or Bachelor’s degree may substitute for experience

Job description

Job Description

We are searching for a Patient Access Rep. Someone who will ensure timely and accurate patient registration by serving as the liaison between patient/family, payers, Healthcare Information Management (Medical Records), Patient Financial Services (PFS or Business Services) and other health care team members. While utilizing a unique medical record number, the Patient Access Representative will facilitate patient tracking and billing by obtaining/verifying accurate and complete demographic information, financially securing, and collecting out-of-pocket responsibility from guarantors to maximize hospital reimbursement. Maintain compliance with EMTALA, The Joint Commission, and all other hospital and government regulations applicable to the Admissions setting. Identify non-resource patients for possible eligibility for government resources and/or the Hospital's charity program and refer these patients to a financial counselor.

Responsibilities

• Obtains, verifies, and enters complete and accurate demographic information on all accounts to facilitate smooth processing through the revenue cycle.
• Thoroughly searches the patient accounting system for an existing medical record on each visit. Uses appropriate search techniques to ensure that no duplicate medical records are created in the master patient index.
• Accurately enters complete demographic information into the system. Verified information should include correct spelling of patient name, date of birth, gender, address, phone number, guarantor data, etc. Patient names should follow hospital protocol regarding middle names, suffixes, etc.
• Ensures assigned DARs and/or work queues are monitored and worked on a daily basis, ensuring that all elements of the accounts are secured for billing. Responsibility
• Financially secures all patient accounts to maximize hospital reimbursement in a customer service oriented fashion.
• Verifies insurance benefits for all plans associated with patient, confirming the correct payor and plan is entered into EPIC. Enters patient estimates in estimating software if required.
• Obtains insurance referrals, as required by individual insurance plans, documenting referral numbers in the appropriate fields for accurate billing. Documents whether authorization is require and involves Authorization Specialist when needed for clinical authorizations.
• Provides estimates of patient liability to patient/guarantor prior to visit as part of financially securing the account. Involves financial counseling department for self pay accounts requiring assistance with funding.
• To provide the highest possible customer service, patients are pre-registered 2-10 working days in advance of appointment/admission.
• Registers unscheduled patients as soon as notified, obtaining insurance benefits and referrals/authorizations prior to providing services or prior to discharge.
• Obtains clinical and financial authorization as required by contract for services.
• For patients who are admitted as inpatient from outpatient areas: verifies inpatient benefits, notifies bed control, and begins the pre-certification process.

Qualifications

• H.S. Diploma required
• 6 months experience as an admissions representative/counselor performing all aspects of the registration process preferred.
• Associate or bachelor’s degree may be substituted for the experience

About Us

Since 1954, Texas Children’s has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children’s hospital in Texas, and among the top in the nation by U.S. News & World Report as well as recognition from Houston Business Journal as one of this city’s Best Places to Work for ten consecutive years. Texas Children’s comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Tower for pediatric research; Texas Children ’s Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children ’s Hospital West Campus, a community hospital in suburban West Houston; Texas Children ’s Hospital The Woodlands, the first hospital devoted to children ’s care for communities north of Houston; and Texas Children’s Hospital North Austin, the new state-of-the-art facility providing world-class pediatric and maternal care to Austin and Central Texas families. We have also created Texas Children ’s Health Plan, the nation ’s first HMO focused on children; Texas Children ’s Pediatrics, the largest pediatric primary care network in the country; Texas Children ’s Urgent Care clinics that specialize in after-hours care tailored specifically for children; and a global health program that is channeling care to children and women all over the world. Texas Children ’s Hospital is affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation. To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.