Patient Service Representative I

Position Summary

The Patient Access Representative is responsible for providing exceptional front-line customer service while ensuring accurate patient registration, insurance verification, and financial clearance. This role supports efficient patient flow and compliance with organizational policies and payer requirements.

Education & Experience

• High school diploma or GED required
• Preferred experience in one or more of the following:
  • Patient access (scheduling, registration, financial clearance)
  • Insurance verification and billing
  • Certified Medical Assistant (CMA) experience

Reporting Structure

• Reports to: Supervisor or Manager

Licensure/Certification

• None required

Key Responsibilities

• Greet and assist patients upon arrival, ensuring a courteous and efficient check-in process
• Monitor patient flow to support timely and effective service delivery
• Accurately verify and update patient demographic and insurance information
• Complete registration for walk-in patients and ensure all records are current
• Verify insurance benefits and determine patient financial responsibility
• Collect copays, deductibles, outstanding balances, and estimated payments
• Follow financial clearance policies for non-urgent services, including authorization requirements
• Identify patients requiring financial assistance and refer to Financial Counseling as appropriate
• Perform visit closure activities including patient check-out, scheduling follow-up appointments, and providing necessary documentation
• Maintain working knowledge of Medicare, Medicaid, and third-party payer guidelines, including pre-authorization requirements
• Communicate customer service concerns and process improvement opportunities to leadership
• Meet established productivity and accuracy standards (minimum 98% accuracy rate)
• Foster positive relationships with patients, families, and clinical staff to support effective communication and care coordination

Skills & Qualifications

• Strong problem-solving and critical thinking skills with the ability to interpret data and make informed decisions
• Knowledge of Medicare, HIPAA, EMTALA regulations, and insurance pre-certification requirements
• Basic understanding of medical terminology, human anatomy, and clinical procedures
• Excellent verbal and written communication skills with a professional and customer-focused demeanor
• Ability to handle confidential information in accordance with organizational policies
• Proficiency in Microsoft Outlook, Word, Excel, and registration systems (ADT preferred)
• Basic math skills, including calculating balances, percentages, and patient financial responsibility
• Ability to work independently in a fast-paced, high-volume environment while prioritizing tasks effectively

Work Environment

• Standard office/clinical environment
• Prolonged periods of sitting throughout the workday
• Occasional lifting of up to 10 lbs
• Regular use of office and registration equipment