Patient Access Specialist I - CommonSpirit Health

In 2020, united in a fierce commitment to deliver the highest quality care and exceptional patient experience, Virginia Mason and CHI Franciscan Health came together as natural partners to build a new health system centered around the patient: Virginia Mason Franciscan Health. Our combined system builds upon the scale and expertise of our nearly 300 sites of care, including 11 hospitals and nearly 5,000 physicians and providers. Together, we are empowered to make an even greater impact on the health and well-being of our communities.      

CHI Franciscan and Virginia Mason are now united to build the future of patient-centered care across the Pacific Northwest. That means a seamlessly connected system offering quality care close to home. From basic health needs to the most complex, highly specialized care, our patients can count on us to meet their needs with convenient access to the region’s most prestigious experts and innovative treatments and technologies.  

Franciscan Medical Group, as part of Virginia Mason Franciscan Health, is currently looking for a full-time Patient Access Specialist I for the fast-paced Franciscan Patient Access team in Tacoma. Flexible work schedule with excellent opportunity for growth. Monday-Friday, 9:30am-6:00pm with occasional weekends required.  Ability to work remotely after successfully completing training and meeting productivity requirements.

Job Summary:

This job is responsible for performing general patient access duties in a centralized call center environment in accordance with establishes standards and procedures.  An incumbent answers incoming phone calls and assists patients with registration, scheduling, insurance and medication refill needs for all providers within an assigned specific specialty.  Work is instrumental in promoting positive outcomes for providers, clinic staff and patients.  

Work includes:  1) verifying demographics and registering patients in Epic; 2) obtaining and verifying insurance coverage; 3) scheduling patient appointments and 4) promoting MyChart activation.  An incumbent may also schedule for special projects (e.g. Healthgrades; Seven Corners, virtual visits, etc.) as assigned.

An incumbent demonstrates full competency in the nuanced scheduling for all providers within the assigned specialty, requiring significant attention to detail, capacity for remembering/applying multiple guidelines and the ability to troubleshoot/problem-solve independently within established parameters.  Employee productivity is measured and results shared on a scheduled basis to assure continued expertise and competency in meeting established standards. 

Work requires knowledge of patient registration and insurance verification processes, privacy/confidentiality standards, as well as knowledge of medical terminology and the ability to utilize all available resources/tools to problem-solve in a timely, efficient and effective manner.  An incumbent follows proper channels of communication in handling daily and routine problems and recognizing issues that need referral/escalation to management.  Strong customer service skills are also necessary. 

If ASSIGNED TO PATIENT ACCESS SPECIALIST II:

This job is responsible for performing the duties associated with I level for multiple assigned specialties.  Work at this level requires additional training and expertise in visit types, reviewing/attaching referrals to the visit, differences between in-network insurances and other special imaging/scheduling requirements.  Also scheduling for providers in multiple specialties requires additional patience/flexibility and a broader base of knowledge regarding provider preferences and scheduling nuances.

Essential Duties: 

Answers incoming phone calls from patients who need to schedule an appointment; meets standards for established quantity and quality of calls answered.  (50%)

• Schedules (and reschedules as necessary) patient clinic visits (based on authorized referral in the case of specialty clinics) in accordance with established standards and procedures; Utilizes Epic Provider Vista to facilitate timely and accurate appointment scheduling; searches multiple provider schedules concurrently; accesses scheduling guidelines for each individual provider and applies scheduling preferences as appropriate; cross-schedules patients with providers who have the earliest availability.  
• Applies understanding of the differences between visit types and when each type of appointment can be scheduled to facilitate accurate scheduling.  
• Provides basic information in response to patient questions within scope of position; follows established procedures to assure that all registration guidelines/requirements have been satisfied; identifies deficiencies and resolves non-complex issues or escalates to appropriate staff for further action.
• Makes arrangements for addressing special/ancillary patient requirements, including transportation, interpreters and other needs relating to patient care and satisfaction.  

Answers incoming phone calls from patients requesting a medication refill; sends messages back to office staff in correct format and including all necessary information.  (25%)

• Applies knowledge of Epic smart phrases for various message types and where to locate medication/pharmacy information in the patient’s Epic chart to identify correct medication is being requested.  
• Determines, based on established guidelines, if a provider appointment is necessary to discuss the medication and schedules appointment; if appointment is unnecessary, assures, within scope of position, request for correct medication and sends message to back office of call-receiving clinic to initiate the refill as appropriate.  

Verifies insurance coverage at the time of scheduling to secure patient account reimbursement and decrease eligibility denials. (15%) 

• Obtains/validates demographic, insurance and related medical information at the time of scheduling to support the patient’s ability to make a reimbursable claim to their health insurance provider and avoid delays; marks account as self-pay or verifies insurance coverage as appropriate.
• Determines if the patient’s insurance plan is contracted by checking against existing resources/tools (e.g. Real Time Eligibility function in Epic, etc.); may need to verify the plan online, via phone call or fax; utilizes “generic” insurance coverage options if appropriate to complete required fields; assures complete registration/insurance verification to avoid delay in claims processing. 
• Applies knowledge of how to load the plan into Epic, how to determine filing order when a patient has multiple coverages and when to use Personal/Family Insurance coverage vs. an MVA or L&I Claim.  

Performs ancillary administrative tasks as requested. (10%)

• Accesses work queue of pre-appointment missing registration items to assure all necessary registration information is included to facilitate claim generation for the appointment; resolves incomplete/incorrect information per established guidelines.  
• Reviews status of MyChart activation for all patients who call in; encourages advantages of activation, sends activation code (via instant activate process) to interested patients who are not currently active; provides instruction to patients having difficulty with the activation process.   
• Checks Patient Access Voicemail Box, from office or home, to access and respond to messages within established time parameters (within 24 hours). 
• Checks in-basket messages with details regarding patients who have called after hours to cancel/reschedule an appointment; may call patient to clarify needs and better assist with rescheduling and/or request.  

Performs related duties as required.

Education/Work Experience:

• One year of customer service work experience is required.  Healthcare environment experience is preferred.