Patient Access Center Representative (Referral Management) - Katy

Overview
At Houston Methodist, the Patient Access Center Representative position is responsible for assuring that patients referred between employed and aligned physicians are scheduled to receive services in their assigned location and are financially cleared prior to their scheduled appointment through accurate and timely scheduling, registration, and verification of eligibility and benefits. This position assists management with ongoing observations and notifications of opportunities while providing innovative suggestions for process improvement. The Patient Access Center Representative position also assists management with auditing/quality review to ensure accurate and appropriate scheduling and registration. Additional responsibilities for this position include providing excellent customer service when communicating with patients who visit our clinics and providing notification to patients, physicians and management of issues that may result in potential service delays or reimbursement denials.
Houston Methodist Standard
PATIENT AGE GROUP(S) AND POPULATION(S) SERVED
Refer to departmental "Scope of Service" and "Provision of Care" plans, as applicable, for description of primary age groups and populations served by this job for the respective HM entity.
HOUSTON METHODIST EXPERIENCE EXPECTATIONS

• Provide personalized care and service by consistently demonstrating our I CARE values:
  • INTEGRITY: We are honest and ethical in all we say and do.
  • COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
  • ACCOUNTABILITY: We hold ourselves accountable for all our actions.
  • RESPECT: We treat every individual as a person of worth, dignity, and value.
  • EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.

• Practices the Caring and Serving Model

• Delivers personalized service using HM Service Standards

• Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)

• Intentionally collaborates with other healthcare professionals involved in patients/customers or employees' experiential journeys to ensure strong communication, ease of access to information, and a seamless experience.

• Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job

• Displays cultural humility, diversity, equity and inclusion principles

• Actively supports the organization's vision, fulfills the mission and abides by the I CARE values

Responsibilities
PEOPLE ESSENTIAL FUNCTIONS

• Demonstrates ability to use critical thinking skills and healthcare knowledge to manage through primary care and specialty care scheduling processes. Utilizes independent judgement to accommodate special requests from internal and external customers as indicated.

• Serves as the front door of the Physician Organization interacting with new and established patients providing them with information needed to schedule and register multiple services for the Physician Organization. Utilizes computerized scheduling/registration systems, verification systems, and online applications while balancing departmental resources. Obtains required data in order to support departmental and hospital clinical/financial needs.

• Triages calls for the Patient Access Center as appropriate to other areas as received on a daily basis while working under the guidelines and scripts as set forth by management. Provides patients with information needed to prepare for appointment per Center/Service protocol. Enrolls patients on the Patient Portal and provides PIN numbers, complying with HIPAA regulations.

• Follows clinical protocols directly as indicated by Kyruss Provider Match, management, and physicians on an as needed basis and consistently manages multiple software applications to schedule appointments.

• Keeps open channels of communication with all parties involved, including physician, patient, and service areas, regarding action taken and resolution. Promotes a friendly and professional customer service environment.

SERVICE ESSENTIAL FUNCTIONS

• Utilizes courteous and professional telephone techniques and interpersonal skills to establish and maintain rapport with patients, physicians/office personnel and various hospital personnel, while maintaining patient confidentiality. Appropriately utilizes ACD/CISCO telephone system. Uses department scripting and appointment scheduling policy when scheduling appointments and ensures ICARE values are met while working within the scripting provided. Assists with new referral from E-fax and emails along with specific doctors' offices calling directly to schedule emergency patients' same day or within 24 hours.

• Coordinates the flow of patient referrals:
  - Collects and compiles data/information from patients such as insurance documentation and patient identification information to help facilitate an appointment with a SPG/PCG provider.
  - Screens and assesses patient calls received and assures that the patients are scheduled for services as requested by referring physician.
  - Schedules patient appointments.
  - Verifies patient benefits for eligibility.
  - Efficiently completes registration.
  - Pre-certifies with insurance companies if necessary.
  - Answers incoming calls from patients regarding the status of their referrals progress.
  - Acts as liaison between the patient and the physician.
  - Handles calls from physicians' offices, always making sure to maintain a good relationship and obtain all necessary documents needed to support the referral process and close out referral process.

• Helps facilitate, coordinate, and resolve referral issues with patients by exhibiting and exercising exceptional telephone, verbal, written, exemplary critical thinking and interpersonal communication skills. Provides empathetic patient care by focusing on maintaining friendly, and incredibly dynamic environment.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• Maintains HIPPA Guidelines and provides empathetic patient care by focusing on maintaining ICARE values throughout the interaction.

• Maintains standard of productivity set by department policy and procedures and meets scheduling goals set by the department (e.g. abandonment rate, productivity per hour, etc.).

• Utilizes resources to perform verification of patient insurance. Obtains required data in order to support departmental and hospital clinical/financial needs.

• Ensures verification and eligibility procedures are followed prior to patient visit. Provides patients with information needed to prepare for appointment per Center/Service protocol. Enrolls patients on the Patient Portal and provides PIN numbers, complying with HIPAA regulations.

FINANCE ESSENTIAL FUNCTIONS

• Works directly with the revenue cycle team and other departments to ensure the correct information and registration is complete and accurate prior to the patient visiting the clinic. Identifies areas of concern and improvement to better the team and the overall practice in collecting revenue from front end operations being faulty.

• Obtains and enters accurate scheduling and registration data, including but not limited to patient demographics, insurance, guarantor, and clinical information on the information system in order to initiate financial clearance activities (benefit eligibility and verification, pre-certification notification and payment review). Documents patient's accounts with information related to any potential issue(s) that could result in service delays or cancellations due to the lack of financial clearance.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

• Answers calls in a timely manner. Works directly with physicians, office staff and patients to ensure best practices within department. Works with manager to improve areas requiring concern as indicated and strives for excellence in the workplace.

This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.
Qualifications
EDUCATION

• High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)

WORK EXPERIENCE

• Three years of experience in healthcare setting/call center or customer service operations or successful completion of one-year Houston Methodist Call Center Apprenticeship in lieu of years of experience

• Healthcare setting knowledge and experience with a strong understanding of medical terminology preferred

License/Certification
LICENSES AND CERTIFICATIONS - REQUIRED

• N/A

LICENSES AND CERTIFICATIONS - PREFERRED

• CMA - Certified Medical Assistant - Satisfactory program completion and clinical licensure OR
• LVN - Licensed Vocational Nurse - State Licensure - Satisfactory program completion and clinical licensure

KSA/ Supplemental Data
KNOWLEDGE, SKILLS, AND ABILITIES

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations

• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security

• Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles

• Excellent communication and interpersonal skills via telephone and in person

• Demonstrated proficiency in medical terminology to include diagnoses, operative procedures, and CPT codes

• Knowledge of medical terminology and applicability

• Excellent spelling/grammar skills

• Working knowledge of PC environment utilizing Windows and word processing and basic Excel knowledge . Must be able to enter data via keyboard throughout the work schedule

• Capable of working and navigating several applications and websites related to registration simultaneously

• Managed care knowledge with the ability to differentiate between insurance plans such as PPO, POS, HMO, etc.

SUPPLEMENTAL REQUIREMENTS
WORK ATTIRE

• Uniform No
• Scrubs No
• Business professional Yes
• Other (department approved) No

ON-CALL*
*Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.

• On Call* Yes

TRAVEL**
**Travel specifications may vary by department**

• May require travel within the Houston Metropolitan area Yes
• May require travel outside Houston Metropolitan area No

Company Profile
Houston Methodist (HM) is one of the nation's leading health systems and academic medical centers. HM consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the heart of the Texas Medical Center, and seven community hospitals throughout the greater Houston metropolitan area. HM also includes an academic institute, a comprehensive residency program, a global business division, numerous physician practices and several free-standing emergency rooms and outpatient facilities. Overall, HM employs over 25,000 employees. Houston Methodist is supported by a wide variety of business functions that operate at the system level to help enable clinical departments to provide the best patient care and service in a spiritual environment.
In 2019 Houston Methodist and its physicians treat more than 6,333 international patients from more than 76 countries. Houston Methodist Global Health Care Services' consulting and education divisions also provide advisory services and training and development to health care organizations around the world.