Patient Access Rep - Ortho - Full Time

Position Title: Patient Access Representative      
Department: Patient Access                        Safety Sensitive:    ☒  Yes   ☐  No
Reports to: Patient Access Manager            Exempt Status:    ☐  Yes   ☒  No   
                  
Position Purpose

All KHI employees are expected to perform their respective tasks and duties in such a way that supports KHI’s vision to be among the kindest, highest quality health systems in the country.
At the direction of management, completes the registration process for patients.  This includes verification of benefits, discharge of patients, collection of copays or payments, balancing of accounts, and general data entry.

Key Responsibilities 

Customer Service and Patient Satisfaction
•   Provides excellent customer service, contributes to the overall satisfaction of the patient experience, and adheres to the Behavioral Expectations Agreement.
•   Promptly fields and/or directs incoming calls; responds to patient and/or staff inquiries.
•   Refers patient accounts to financial counselors when further explanation/education is needed (denied authorizations, out-of-pocket liabilities, coverage options, payment plans, etc.).
•   Consistently demonstrates a willingness to assist co-workers to support department efficiency and to support positive customer feedback goals. 
•   Participates in on-going process improvement activities for the team.
•   Floats to other work areas, as requested, and regularly works nights, weekends, holidays, and extended hours when needed.
Registration/Admitting/Discharge of Patients
•   Demonstrates ability to preregister, register, schedule, reschedule, and discharge patients according to the defined guidelines. 
o   Enters new patient data and/or verifies patient records are up to date, confirms the completeness of the electronic health record (EHR) and makes changes as necessary. 
o   Verifies insurance eligibility and benefits within a timeframe determined by KHI.
o   Obtains pre-authorizations from third-party payers in accordance with payer requirements, when needed.
o   Ensures identified information are complete and scanned into patients’ electronic health record (EHR) (insurance cards, photo ID’s, physician orders, and other admission documents. 
o   Obtains signatures on all required forms.
o   Demonstrates ability to manage co-payments, deductibles, allowances, etc. as instructed.
Patient Processing
•   Accurately balances daily cash to include completion of daily cash log, bank deposit slip, and daily reports to Patient Financial Services.
•   Accurately utilizes insurance eligibility/audit tools and report/correct variances within the EMR.
•   Quality performance scores must meet defined goals. 
•   Verifies insurance eligibility and benefits within a timeframe determined by KHI and obtains pre-authorizations from third-party payers in accordance with payer requirements.
•   Collects upfront co-pays, deductible and coins securing deposits on self-pay and high accounts. 
•   Regularly works nights, weekends, holidays, and extended hours when needed.

Required Qualifications 
•   Demonstrates ability to multitask, prioritize appropriately, and management time efficiently.
•   Effective oral and interpersonal communication skills. 
•   Demonstrates ability to utilize a variety of technological resources (phone, computer hardware, various software programs, fax, scanner)
Required Education: High School Diploma or equivalent
Required Experience: Minimum of 1 year of experience working in a customer service position and/or office setting
Required Certification: American Heart Association BLS (Basic Life Support) certification

Preferences
Previous experience in healthcare registration, scheduling, and/or authorizations

Special Position Requirements 
Exposure Category II: Expected duties have possible, but not routine, potential for exposure to blood, body fluids or tissues.

Work Requirements 
Able to reach above and below shoulder level, lift, bend, kneel, squat, stand, walk, and sit for the full scheduled shift.
Able to use telephone and computer software and hardware for most of the shift (90% of the day).

Date Staff Position Description Created / Revised: 6/28/2019; 7/1/2019; 9/10/2019; 2/20/2024; 7/16/2025