Patient Access Representative

Position: Patient Access Representative (Onsite)

Position Summary

The Patient Access Representative is responsible for supporting U.S. healthcare organizations with front-end Revenue Cycle Management (RCM) functions. This role focuses on delivering exceptional customer service while accurately completing patient registration, insurance verification, authorization, financial clearance, appointment scheduling, and other patient access activities that improve revenue integrity and patient satisfaction.

Representatives interact professionally with patients, providers, physician offices, insurance companies, and internal client teams while ensuring compliance with HIPAA and client policies.

Primary Responsibilities

Patient Registration

• Register new and returning patients.
• Verify demographic information.
• Update patient records.
• Validate guarantor information.
• Ensure complete and accurate documentation.

Insurance Verification

• Verify eligibility and benefits.
• Confirm coverage dates.
• Determine deductibles.
• Verify co-pay and coinsurance amounts.
• Identify authorization requirements.

Prior Authorization

• Obtain prior authorizations.
• Submit clinical documentation.
• Follow up with insurance companies.
• Document authorization numbers.
• Escalate denials when appropriate.

Financial Clearance

• Estimate patient responsibility.
• Review payment options.
• Explain financial policies.
• Identify financial assistance opportunities.

Appointment Scheduling

• Schedule appointments.
• Reschedule patients.
• Confirm appointments.
• Maintain provider templates.
• Optimize scheduling efficiency.

Customer Service

• Answer inbound calls.
• Make outbound calls.
• Resolve patient inquiries.
• Maintain professionalism.
• Meet quality standards.

Documentation

• Document all account activity.
• Maintain complete notes.
• Update work queues.
• Follow client workflows.

Required Qualifications

• Bachelor's degree preferred.
• Minimum 1 year BPO experience.
• Excellent English communication skills.
• Healthcare experience preferred.
• Strong computer skills.
• Typing speed of 40+ WPM.
• Ability to multitask.
• Strong customer service skills.

Preferred Experience

• U.S. Healthcare.
• Revenue Cycle.
• Epic.
• Cerner.
• Meditech.
• Athena.
• eClinicalWorks.

Key Performance Indicators

• Registration Accuracy ?98%.
• Insurance Verification Accuracy ?98%.
• Authorization Accuracy ?98%.
• Quality Score ?95%.
• Attendance ?97%.
• Productivity meets client goals.
• Average Handle Time within target.
• Customer Satisfaction targets achieved.

Knowledge & Skills

• HIPAA.
• Medical terminology.
• Insurance terminology.
• Medicare.
• Medicaid.
• Commercial insurance.
• Excellent communication.
• Critical thinking.
• Time management.

Work Environment

Work is performed from the company's secure operations center using company-approved systems and security protocols.