Lead Patient Access Representative

Job Description

Job Title: Lead Patient Access Representative (PAR-L)

Department: Patient Services

Supervisor: Health Center Manager

Classification: Non-Exempt/Hourly

Synopsis: The Lead Patient Access Representative (PAR-L) is essential in La Clinica del Pueblo's clinical operations. This position oversees patient registration, benefits assessment, insurance enrollment, and adherence to relevant healthcare programs. Reporting directly to the clinic’s Health Center Manager, this position provides leadership in managing the scheduling guidelines process and contact center, enhancing workflow efficiency, and implementing protocols to optimize patient care.

Qualifications

Required Education and Experience

High School diploma or equivalent or associate degree in a healthcare-related field.

Excellent verbal and written communication in English and Spanish, professional phone etiquette, and interpersonal skills to interact with patients, colleagues, and external agencies.

One (1) year of experience with insurance verification and benefits eligibility. In lieu of one (1) year of experience, at least two (2) years of experience in registration, data entry, or administrative roles, or a combination of understanding and articulating eligibility and benefits, registration, and customer service.

Ability to achieve and maintain certification in DC Health Link and Affordable Care Act credentials within the first year of employment. Understanding the District of Columbia and Maryland Medicaid Program and public assistance benefit application processes.

Preferred Education and Experience

Multi-line phone system – Dialpad a plus.

Proficiency in electronic health records systems, eClinicalWorks a plus, and Microsoft Office.

One (1) year of exceptional internal and external customer service with the ability to work with diverse, underserved populations, Latinos, and the LGBTQ+ community.

Knowledge of medical terminology and practices.

Required Skills/Abilities/Certifications/Licenses

Ability to follow and model adherence to La Clinica’s Standard Operating Procedures (SOPs) and Scheduling Guidelines.

Analytical and critical thinking skills to solve conflicts and problem-solving to meet the patient’s needs. Ability to assist patients and caregivers in challenging situations.

Excellent organizational skills, ability to prioritize multiple projects, data entry skills, and ability to check the accuracy of detailed work.

BLS or CPR certification or willingness to obtain within 90 days of employment.

Preferred Skills/Abilities/Certifications/Licenses

Ability to maintain patient confidentiality and adhere to HIPAA regulations and PHI.

Ability to function in high-volume, multiple-task environments in a closely shared workspace.

Duties and Responsibilities

Promptly respond to incoming calls, Healow messages, voicemails, and faxes from patients, pharmacies, and outside agencies seeking assistance through our Contact Center, ensuring exceptional service delivery. Efficiently document and redirect patients, pharmacies, and other provider inquiries to the appropriate health center personnel.

Handle multi-line telephone systems courteously, directing calls to the relevant team and documenting patient interactions in telephone encounters (TE) in electronic health records (EHR).

Adhere to La Clinica’s Scheduling Guidelines when booking the Clinical Services and Mental Health team templates. Adheres to La Clinica del Pueblo’s Code of Ethical Standards.

Monitor the schedule, minimize unused appointment slots, and pay attention to insurance and uninsured payor mix. Communicate all unforeseen challenges to the Health Center Manager.

Performs patient registration and recertifications and ensures the responsible party correctly fills out and signs documentation. Performs outreach calls to patients in support of Panel Management.

Aid in workflow development and support staff training sessions. Build rapport and provide coaching to ensure optimal team performance.

Responsible for recall system during check-out; collects and applies patient payment; refers to the billing department for payment plans or other insurance-related questions; and reconciles daily cash reports.

Enforce LCDP’s policies and procedures to patients; seek management support as required.

Attends required all-staff meetings and LCDP activities training to increase/maintain skills and complete competency checklists within 90 days of employment and annually.

Investigates, tracks, and responds to patient inquiries promptly, ensuring appropriate administrative and departmental communication. Ensure the patient’s fee scale is appropriately applied to other payer sources, such as Medicare, Medicaid, and other third-party or private insurance.

Screens and refers patients for Social Determinants of Health (SDoH) and assigns care coordination should someone be entitled to additional assistance.

Provide comprehensive monthly reporting of patient statistics and metrics.

Responding to billing discussions or questions related to Sliding Fee charges.

Collaborates with interdisciplinary teams to enhance workflows and achieve organizational goals.

Completes assigned tasks and responsibilities within established guidelines and scope of practice.

Compliance with federal and local patient privacy laws.

Performs other tasks as needed under the direction of the Health Center Manager.

Physical Requirements

Prolonged periods of sitting at a desk, working on a computer, and handling a high volume of incoming and outgoing calls.

Exposure to quiet to moderate noise levels in an office or clinic setting.

Potential exposure to extreme weather conditions and hazardous pathogens requires safety protocol adherence.

Must be able to lift at least 15 pounds at times.

Supervisory Responsibilities: None