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How to Become a Patient Access Representative

Do you have good communication skills, a friendly personality, and are looking for a career in the healthcare field? A patient access representative might be the perfect opportunity for you.

Patient access representatives work in healthcare facilities and are the patient’s first point of contact when they arrive. They typically greet and admit patients to the facility and collect relevant data such as medical history and insurance information. They answer phones in a professional manner, schedule appointments, and submit insurance claims. They also handle patient discharges, including providing patients with billing and payment information. Patient access representatives should be proficient in using computers and entering patient information accurately into relevant databases. They also need good communications skills as they typically explain hospital policies and procedures and respond to patient queries, concerns, and complaints. 

To succeed as a patient access representative, you are required to have excellent office administrative skills and a positive and professional demeanor. A commitment to helping others and compassion are also needed. Good working knowledge of medical terminology and insurance plans, as well as excellent organizational skills, are important in this role. Patient access representative is an entry-level position and a great starting point to launch your career in healthcare.

Sample job description

The patient access representative provides high-level administrative support to the patient access team, including completion of patient medical insurance eligibility, processing benefits, and referral authorizations for patients.You will need to complete daily patient entry, intensive care unit (ICU) listing, or census verification activities to ensure proper patient identification by collecting, entering, and verifying data in order to remove duplicate registrations, verify insurance eligibility with third-party payers, coordinate benefits information for patients/families, and file claims on behalf of the patient with various public or private health insurance carriers. You may also be tasked with updating demographic records in the computer system, maintaining family contacts with insurance companies to resolve claim and benefit issues, assisting patients with questions or concerns related to their hospital stay, or serve as a liaison between patients and other departments within the hospital.

Typical duties and responsibilities

  • Answer phone and schedule appointments
  • Greet patients and visitors to the office
  • Record patients’ medical history and personal information
  • Escort patients around the office
  • Submit insurance forms
  • Copy, file, and maintain paper and electronic documents
  • Handle incoming and outgoing correspondence

Education and experience

Patient access representatives need to have a high school diploma or equivalent. Computer and typing skills and knowledge of the health-care industry are helpful. Employers usually provide on-the-job training that covers specific duties.

Required skills and qualifications

  • Computer skills, including Microsoft Office Suite (Word, PowerPoint, and Excel)
  • Experience with electronic health records (EHRs)
  • Strong customer service skills for dealing with patients
  • Discretion and the ability to handle confidential information
  • Organization skills and the ability to multitask 
  • Compassion and a calm, professional demeanor
  • Keen attention to detail

Preferred qualifications

  • HIPAA certified
  • Knowledge of insurance benefits
  • 3+ years of experience working as a patient access representative
  • Strong interpersonal skills
  • Ability to solve claims in a fast manner

Typical work environment

Working as a patient access representative means you’ll be working in a medical office setting. The operating room is not considered an environment where this type of work may be performed, but you may work in a hospital, clinic, or regular office. They may also liaise with patients and other hospital departments. Patient access representatives must be able to work with insurance companies to resolve claim and benefits issues.

Typical hours

Patient access representatives typically work regular office hours, from 9 AM to 5 PM during the week. However, some medical facilities with extended hours might require evening and weekend shifts.

Available certifications

Though it’s not required to receive certifications, securing one can help you stand out from the other applicants. The most popular certification is:

  • Certified Healthcare Access Associate (CHAA) – This certification validates that your knowledge and skills align with industry standards – showing that you are a reliable, accountable, and trusted patient access professional dedicated to improving patient experience.

Career path

The first step to becoming a patient access representative is to earn a high school diploma or equivalent. Solid communication and computer skills, along with the ability to type, are helpful. Employers also prefer candidates with some knowledge of health care, although they usually provide on-the-job training for their specific needs.

US, Bureau of Labor Statistics’ job outlook

SOC Code: 29-2098

2020 Employment335,000
Projected Employment in 2030363,600
Projected 2020-2030 Percentage Shift 9% increase
Projected 2020-2030 Numeric Shift28,600 increase

Patient access representative is an entry-level position, and some people use it as a springboard to other jobs with more responsibility in the health-care industry. Candidates with computer and database skills will have the upper hand. The aging population means demand for health care workers should remain robust. 

The American Society of Administrative Professionals provides training and resources for people who work in this field.