Patient Access Team Specialist at DME Service… · Location…

Patient Access Team Specialist

Key Responsibilities

Patient Access Team (PAT) Services

• Conduct patient screening to identify service needs, referral requirements, and appropriate care pathways.
• Verify patient eligibility for services, insurance coverage, payer requirements, PCP assignments, IPA affiliations, and authorization needs.
• Schedule patient appointments directly in EPIC (OCHIN) following established templates, provider schedules, routing rules, clinical restrictions, and specialty-specific workflows.
• Verify and review laboratory results as required to ensure patients meet appointment, treatment, or program requirements prior to scheduling or care delivery.
• Screen patients for eligibility under the Sliding Fee Discount Program and document outcomes in accordance with organizational policies and regulatory requirements.
• Perform appointment readiness verification by confirming required documentation, referrals, authorizations, insurance eligibility, laboratory results, and other visit prerequisites.
• Provide care pathway navigation and patient education, helping patients understand available services, appointment requirements, referral processes, and next steps in their care journey.

Patient Scheduling & Intake

• Schedule patient appointments directly in EPIC (OCHIN) following established templates, routing rules, provider schedules, and clinical restrictions.
• Complete full patient intake, including validation of demographics, PCP/IPA assignment, and referral requirements.
• Follow appointment scheduling workflows, including specialty-specific requirements and visit-type rules.

Insurance Eligibility & Coverage Verification

• Verify patient insurance eligibility, coverage details, and plan requirements at the time of the call using approved systems and EPIC tools.
• Confirm PCP assignments, IPA affiliations, and authorization needs based on payer rules.
• Follow all eligibility verification workflows to ensure accurate and compliant patient scheduling.

Call Handling & Customer Support

• Handle high‑volume inbound calls; outbound and conference calls may also be required.
• Meet and maintain performance metrics including:
  • 100+ calls per day (inbound, outbound, and conference combined).
  • Average Handle Time (AHT): 5 minutes.
• Use approved scripts, call flows, and routing protocols to ensure consistent and compliant patient interactions.
• Provide clear, courteous, and professional communication throughout every patient engagement.

Documentation & Chart Completion

• Document call details, actions taken, and patient interactions accurately in EPIC.
• Ensure complete chart closure and proper handoff to downstream teams.
• Maintain accuracy and completeness of patient records in compliance with organizational policies.

Compliance, Security & Training

• Maintain strict adherence to HIPAA, data privacy standards, and role-based system access rules.
• Participate in all required training, including EMR proficiency, eligibility workflows, call handling, and compliance modules.
• Follow internal quality, security, and regulatory policies at all times.

Required Skills & Qualifications

Experience

• Required: Hands-on experience using EPIC (preferably OCHIN environment).
• Required: Previous experience in patient scheduling, medical call center operations, or clinical front office support.
• Required: Inbound call experience in a high-volume environment.
• Experience with insurance eligibility, medical terminology, and payer workflow processes is preferred.

Skills

• Strong navigation and multitasking skills within EMR and payer systems.
• Excellent critical thinking and analytical skills for interpreting eligibility details and resolving scheduling challenges.
• Strong verbal communication and service‑oriented professionalism.
• Ability to follow structured workflows, scripting, and routing requirements with accuracy.
• Fast learner with strong attention to detail, reliability, and follow‑through.

Other Requirements

• Ability to work in an onsite set‑up as required by business operations.
• Ability to maintain productivity and quality in a fast‑paced, high-volume patient access environment.

Process Workflow (Based on Provided Diagram)

The role includes responsibilities across the full patient scheduling cycle:

1. Start
2. Patient Intake & Verification
3. Insurance Eligibility & PCP/IPA Validation
4. Appointment Scheduling & Restrictions
5. Financial Screening & Authorization (as applicable)
6. Documentation & Chart Closure
7. End