Patient Access Representative II en La Clinica del Pueblo

                                                                                          La Clinica del Pueblo 

                                                                                              Job Description 

Job Title: Patient Access Representative II (PAR II) 

Department: Patient Services – Clinical Operations 

Supervisor: Health Center Manager 

Location: Onsite in Washington, DC

Classification: Non-Exempt/Hourly 

Synopsis: The Patient Access Representatives II is vital in supporting the contact center with incoming calls, scheduling clinical and mental health services appointments at all La Clínica del Pueblo (LCDP) sites, and conducting eligibility assessments for the sliding fee scale and insurance, adhering to program-specific guidelines. PAR II is responsible for registration, insurance enrollment, benefits, and eligibility, as well as collecting income, residential, and identification documents to determine sliding fee scale eligibility for La Clinica del Pueblo’s patients. PAR II seeks to maximize benefits available in private and public programs to preserve LCDP’s discount as the payer of last resort.  

Qualifications 

Required Education and Experience 

• High School diploma, G.E.D., or equivalent; Associate degree in a healthcare-related field preferred.
• Minimum of one (1) year of experience in the DC/Maryland Medicaid Program, public assistance benefit applications, insurance verification, and benefits eligibility.
• Two (2) years of experience in insurance verification, benefits eligibility, and Sliding Fee Scale (SFS) determination.
• In lieu of experience, a combination of insurance benefits knowledge and enrollment expertise or two (2) years of customer service experience with a willingness to learn.
• Successful completion of the Certified Application Counselor designation within six (6) months of hire.

Preferred Education and Experience  

• Experience working in a healthcare setting with insurance and billing responsibilities.
• Experience assisting patients with enrollment in health insurance programs.
• Familiarity with multi-line phone systems; experience with Dialpad is a plus.
• Strong verbal and written communication skills, professional phone etiquette, and interpersonal skills for engaging with patients, families, healthcare team members, and external agencies.
• Analytical and critical thinking skills for resolving conflicts and problem-solving to support patient needs.
• Proficiency in data entry with high attention to detail.
• Ability to maintain productivity while working in a team-oriented environment.
• Commitment to adhering to and modeling La Clínica’s Standard Operating Procedures (SOPs) and Scheduling Guidelines.

Required Skills/Abilities/Certifications/Licenses  

• Strong organizational skills and the ability to maintain patient confidentiality.
• Effective problem-solving skills for scheduling conflicts, missing documentation, and other challenges.
• Bilingual in English and Spanish with strong verbal and written communication skills.
• BLS or CPR certification (or willingness to obtain within 90 days of employment).
• Excellent customer service skills with experience serving diverse, underserved populations, including the LGBTQ+ community.

Preferred Skills/Abilities/Certifications/Licenses 

• Experience coordinating patient care with external healthcare organizations and facilities.
• Compassion and ability to assist patients and caregivers in challenging situations.
• Strong organizational skills to ensure the security and confidentiality of patient information.

Primary Essential Duties and Responsibilities 

• Verify patient insurance eligibility and benefits, maintaining accurate records for audits and prioritizing workload effectively.
• Explain billing policies and service fees to patients.
• Educate patients about insurance co-pays, deductibles, and available coverage programs.
• Assist uninsured or underinsured patients with the Sliding Fee Scale application process.
• Register and recertify patients, ensuring all documentation is completed accurately.
• Accurately document patient information in medical records and verify data entry accuracy.
• Screen patients for Social Determinants of Health (SDoH) and obtain prior authorizations for Mental Health Services.
• Participate in Open Enrollment Season activities, including outreach and application assistance.
• Attend training sessions and meetings to ensure compliance with program requirements.
• Meet quality and productivity standards set by the supervisor or designee.
• Maintain patient confidentiality, adhere to HIPAA regulations, and uphold a safe work environment.
• Actively participate in the Patient-Centered Medical Home (PCMH) transformation process.
• Perform other duties as assigned by the supervisor or designee.

Secondary Responsibilities 

Patient Account Representative Support 

• Check in patients for their appointments.
• Assist with pre-registration and insurance verification.
• Inform patients about and collect payments, including SFS fees, account balances, co-pays, diabetes supplies, prenatal vitamins, and donations.
• Refer patients to the billing department for payment plans or insurance-related inquiries.
• Reconcile daily cash reports.
• Provide educational materials relevant to patients’ visits.
• Enroll and guide patients in using the patient portal.
• Schedule follow-up appointments and pre-visit lab orders per provider instructions.
• Ensure patients leave with all necessary referrals, prescriptions, and appointment summaries. 

Contact Center Support 

• Answer multi-line phone systems courteously and direct calls appropriately.
• Document patient interactions accurately in electronic health records (EHR).
• Respond promptly to calls, Healow messages, voicemails, and inquiries from pharmacies and external agencies.
• Contact unconfirmed patients regarding upcoming appointments.
• Schedule American Sign Language (ASL) and language interpreters for patient visits.
• Manage appointment rescheduling and cancellations.
• Coordinate pending provider recalls and schedule necessary follow-ups.
• Assist with pre-registration and inform patients of required documentation for enrollment.
• Adhere to LCDP’s Scheduling Guidelines and promptly communicate any scheduling challenges to the supervisor.

Physical Requirements 

• Prolonged periods of sitting at a desk, working on a computer, and handling a high volume of calls.
• Must be able to lift at least 15 pounds at times.

Supervisory Responsibilities: None 

Rev. 10/2022