Patient Access Specialist I/II - Pediatric

In accordance with Navajo Nation and federal law, TCRHCC has implemented an Affirmative Action Plan pursuant to the Navajo Preference in Employment Act. Preference in hiring and employment is given to applicants who are enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe, legally married to enrolled members of these tribes and meet residency requirements, or enrolled members of other federally-recognized American Indian Tribes.

About the role

The primary purpose of the Patient Access Specialist is to schedule and register patients by accurately collecting and analyzing all patients’ demographic, third-party coverage (i.e., insurance), and clinical data elements. This role involves interviewing patients, assisting with required forms for medical, dental, and pharmacy billing claims, and ensuring data integrity to expedite third-party reimbursement and optimize customer satisfaction. The position requires working under frequent interruptions and a flexible schedule, along with performing various clerical duties such as scheduling appointments and managing provider schedules.

Responsibilities

• Review, update, and maintain all patient data in multiple patient accounting, registration, and scheduling systems by completing required forms for billing and admissions.
• Interview patients to obtain pertinent registration information, verify insurance coverage, and communicate any co-pays or deductibles for collection.
• Identify patient’s potential financial liability and refer patients at risk for inability to meet financial obligations to appropriate agencies or departments.
• Provide an overview of options available to patients/families and assess their understanding of the registration process.
• Collect cash payments for pharmacy and medical services and complete necessary reconciliation in accordance with fiscal policy.
• Perform insurance verification and prior authorization for patients before scheduled appointments or procedures.
• Assist patients in completing and updating forms required for medical records, third-party insurers, and the facility.
• Perform all activities of an admitting office (e.g., admitting, discharge, transfer, pre-admissions, pre-verification) for all patient types, ensuring ADT (Admissions Discharge Transfer) data integrity.
• Identify and pre-authorize patients whose health benefits require prior approval for both inpatient and outpatient care.
• Collaborate with various departments to expedite patient services and improve patient satisfaction.
• Serve patients and visitors by welcoming and greeting them in person or by telephone, answering inquiries, and directing them appropriately.
• Work rotational shifts, including call-back schedules for emergencies and inpatient care.
• Intake and coordinate motor vehicle accidents and workers' compensation claims, directing them to appropriate personnel.
• Follow established guidelines for patient identification and income screening for non-eligible Medicaid patients.
• Work with software systems for clinical, medical, dental, pharmacy, and other healthcare office systems.
• Ensure required requisitions for various departments are completed and routed timely, and maintain unit stock of forms and supplies.
• Retrieve and print laboratory reports, health summaries, medication lists, and other patient records as needed.
• Responsible for electronic health records data entry pertinent to the patient service role.
• Ensure proper PPE is always worn while on duty and follow CDC guidelines for donning, doffing, and disposal of PPE.
• Complete routine cleaning and decontamination processes for surfaces contaminated by communicable diseases.
• Perform other duties as assigned.

Requirements

Education

• High School diploma or GED.

Experience

• Patient Access Specialist I: Six (6) months of experience working in a fast-paced office environment with the ability to manage and prioritize multiple assignments and meet tight deadlines.
• Patient Access Specialist II: Two (2) years of experience working in a fast-paced office environment with the ability to manage and prioritize multiple assignments and meet tight deadlines. Experience with electronic patient registration software or similar patient financial services software.

Certification

• Must maintain a current valid Basic Life Support (BLS) certification from the American Heart Association throughout employment.

Other Skills and Abilities

• Excellent customer service and communication skills, both personal and telephone.
• Proficient knowledge and ability to use computer software.
• Ability to complete special projects, meet departmental deadlines, analyze, research, and troubleshoot.
• Demonstrated ability to solve problems following the chain of command.
• Experience with special projects to meet department demands; ability to work independently and resolve issues.
• Positive communication and working relationships with others.
• Possession of high ethical standards and no history of complaints.
• Reliable and dependable; reports to work as scheduled without excessive absences.
• Ability to handle sensitive and confidential information.
• Proficient typing skills with accurate spelling and grammar.
• Ability to work independently with minimal to no supervision.
• Ability to work under conditions of frequent interruptions and a flexible schedule.
• Ability to communicate with patients and families during times of emotional and physical stress.
• Responds positively to supervision to enhance and improve work performance outcomes.
• Successful completion of background and reference checks, fingerprint clearance, physical examinations, and other screenings.
• Submission of all required employment-related documents free of false, misleading, or incomplete information.

Mental and Physical Effort

The physical and mental demands described are representative of those that must be met to successfully perform the essential functions of this job. Reasonable accommodation may be made to individuals with disabilities.

Physical

• Mostly sedentary work requiring continual ability to sit, stand, walk, twist, and reach for long periods.
• Interviewing patients and preparing paperwork for treatment or chart initiation.
• May need to push, pull, and lift up to 10 pounds.
• Continual near vision, color vision, and ability to see fine detail.
• Hearing normal speech, overhead pages, and telephone use; occasional far vision.
• Hand manipulation ability for simple grasping and keyboard use.
• Continual exposure to infectious diseases, dust, fumes, gases, and loud noises.

Mental

• Effectively communicate with patients to obtain accurate information and explain its necessity.
• Cope with high levels of stress and make decisions under pressure.
• Handle anger, fear, or hostility from others calmly.
• Concentrate, work alone, and demonstrate patience.
• Adapt to shift work and handle multiple priorities in stressful situations.
• Accept a flexible schedule to meet business needs.