Patient Access Specialist I/II - Insurance Verifier

Navajo Preference Employment Act In accordance with Navajo Nation and federal law, TCRHCC has implemented an Affirmative Action Plan pursuant to the Navajo Preference in Employment Act. Pursuant to this Plan and corresponding TCRHCC Policy, applicants who meet the necessary qualifications for this position and (1) are enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe will be given preference in hiring and employment for this position, (2) are legally married to enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe and meet residency requirements will be given secondary preference, and (3) are enrolled members of other federally-recognized American Indian Tribes will be given tertiary preference. Overview POSITION SUMMARY The primary purpose of the patient access specialist -Insurance Verifier is accurately verifying and analyzing all patients’ third party coverage (i.e., insurance), Incumbent uses tools and portals and will interview patients and assist them in completing required forms to process medical, dental and pharmacy billing claims. Incumbent is responsible for data integrity to further expedite third party reimbursement and optimize customer satisfaction. A thorough understanding of different insurance plans and coverage terms and/or conditions is required. This position requires the ability to work under conditions of potential interruptions and willingness to work flexible schedule, in the registration office, as well as remotely once productivity standards and quality standards are met. Incumbent also initiates and carries out a variety of clerical duties in order to assist with carrying out the duties and reporting of the patient registration goals and duties. Qualifications NECESSARY QUALIFICATIONS Education: High School diploma or GED Experience: Patient Access Specialist I: Must have six (6) months of experience working in a fast-paced office environment Patient Access Specialist II: Must have two (2) years of experience working in a fast-paced office environment with experience with electronic patient registration software, or similar patient financial services Certification: Must maintain a current valid certification of the following throughout employment, if onsite: Basic Life Support (BLS) from the American Heart Association Other Skills and Abilities: A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers. All employment references must address and indicate achievement in each one of the following areas: Must have excellent customer service skills, personal and telephone communication skills Ability to manage multiple priorities and deadlines. Proficient knowledge and ability to use computer software Demonstrate through work history the ability to complete special projects; the ability to meet departmental deadlines, analyze, research, and troubleshoot. Demonstrates the ability to solve problems following chain of command Experience with special projects to meet department demands, must work independently, analyze, research, troubleshoot 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 manage sensitive and confidential information Must be proficient with typing and accurate spelling and grammar Ability to work independently with minimal to no supervision Ability to work under conditions of frequent interruptions and availability to work a flexible schedule Possess and employs an ability to communicate with patients and families during time of emotional and physical Responds positively to supervision to enhance and improve work performance Completion of above-satisfactory scores on all job interviews, demonstrating to the satisfaction of the interviewees and TCRHCC that the applicant can perform the essential functions of the job Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers demonstrating to the satisfaction of TCRHCC a record of satisfactory performance and that the applicant can perform the essential functions of the job Successful completion of fingerprint clearance requirements, physical examinations, and other screenings indicating that the applicant is qualified to be employed by TCRHCC and demonstrating to the satisfaction of TCRHCC that the applicant can perform the essential functions of the job Submission of all required employment-related documents, applications, resumes, references, and other required information free of false, misleading, or incomplete information, as determined by TCRHCC. MENTAL AND PHYSICAL EFFORT The physical and mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be given to individuals with disabilities to perform the essential functions. Physical: Work is mostly sedentary requiring continual ability to sit, stand, walk, twist, and reach for long periods of time. Incumbent will be interviewing patients and preparing the appropriate paperwork for treatment of a patient or initiating a chart. May need to push, pull, and lift up to 10 pounds in the work area. The Incumbent must have the ability for continual near vision, color vision, seeing in fine detail, hearing normal speech, hearing overhead pages over a loudspeaker, telephone use, and occasional ability for far vision. Must have hand manipulation ability simple grasping and use of keyboards. Incumbent will have continual exposure to infectious disease; dust, fumes, gases; and loud noises. Mental: Must be able to effectively communicate to the patient what specific information is needed, the reason for requesting such – information and be able to ascertain that it is accurate as possible. Consequences of obtaining inaccurate information may delay necessary medical treatment, delay billing process, and cause unnecessary frustration and problems. Incumbent must be able to cope with high level of stress; make decisions under high pressure; cope with anger/fear/hospitality of others in a calm way; concentrate; work alone; demonstrate high degree of patience; adapted to shift work; and manage multiple priorities in stressful situations. Incumbent must accept a flexible schedule to meet all business needs Responsibilities ESSENTIAL FUNCTIONS: Review, update, and maintain all patient insurance data in multiple patient accounting, registration, and scheduling systems by initiating the completion of forms required for billing and Interview patients if needed to obtain pertinent registration information, assure document scanning, retrieving, and editing, and patient identification to determine patient’s insurance coverage, limitations and communicates to patients any co-pays or deductibles for collection. Identify patient’s potential financial liability for a specific service and identify patients at risk for inability to meet financial liability. Make referral to an appropriate agency or department. Provide an overview of options available to patients/families by assessing patient understanding of registration process to determine appropriate response to patient’s questions and applications and communicate appropriate information needed to complete patient’s eligibility Perform insurance verification and prior authorization for patients prior to patient’s schedule appointment or Assist patients in completing and updating forms required for medical records, third party insurer and the Identify and pre-authorize patients whose health benefits are subject to prior approval to determine the extent of health care for both inpatient and outpatient Collaborate with various departments to expedite patient services and improve patient Serve patients and visitors by welcoming and greeting them in person and or telephone; answering or referring inquiries; directing patients and Intake and coordinate motor vehicle accidents/worker’s compensation claims visits that are encountered during shift to appropriate Follow established guidelines regarding patient identification and income screening for the non-eligible Medicaid patients according to provided technical training Work with software systems for clinical, medical, dental, pharmacy and other office healthcare Assure required requisitions for various departments are completed and timely routed as appropriate. Ensure unit is stocked with appropriate forms and supplies. Retrieve and print laboratory reports, health summaries, medication lists, and other patient records as Responsible for electronic health records data entry pertinent to patient service Ensure proper PPE is always worn while on duty including but not limited to, face mask, gloves, gown, isolation gown, NIOSH-approved N95 filtering facepiece respirator or higher, if available), and eye or face shield. Complete all donning and doffing tasks in a safe acceptable method and discard of used PPE accordingly. (See CDC website for most current updates) Complete task training for all routine cleaning and decontamination processes for all surfaces contaminated by a communicable disease to ensure a high level of patient, visitor, employee, and external customer satisfaction. Perform other duties as ESSENTIAL FUNCTIONS: Review, update, and maintain all patient insurance data in multiple patient accounting, registration, and scheduling systems by initiating the completion of forms required for billing and Interview patients if needed to obtain pertinent registration information, assure document scanning, retrieving, and editing, and patient identification to determine patient's insurance coverage, limitations and communicates to patients any co-pays or deductibles for collection. Identify patient's potential financial liability for a specific service and identify patients at risk for inability to meet financial liability. Make referral to an appropriate agency or department. Provide an overview of options available to patients/families by assessing patient understanding of registration process to determine appropriate response to patient's questions and applications and communicate appropriate information needed to complete patient's eligibility Perform insurance verification and prior authorization for patients prior to patient's schedule appointment or Assist patients in completing and updating forms required for medical records, third party insurer and the Identify and pre-authorize patients whose health benefits are subject to prior approval to determine the extent of health care for both inpatient and outpatient Collaborate with various departments to expedite patient services and improve patient Serve patients and visitors by welcoming and greeting them in person and or telephone; answering or referring inquiries; directing patients and Intake and coordinate motor vehicle accidents/worker's compensation claims visits that are encountered during shift to appropriate Follow established guidelines regarding patient identification and income screening for the non-eligible Medicaid patients according to provided technical training Work with software systems for clinical, medical, dental, pharmacy and other office healthcare Assure required requisitions for various departments are completed and timely routed as appropriate. Ensure unit is stocked with appropriate forms and supplies. Retrieve and print laboratory reports, health summaries, medication lists, and other patient records as Responsible for electronic health records data entry pertinent to patient service Ensure proper PPE is always worn while on duty including but not limited to, face mask, gloves, gown, isolation gown, NIOSH-approved N95 filtering facepiece respirator or higher, if available), and eye or face shield. Complete all donning and doffing tasks in a safe acceptable method and discard of used PPE accordingly. (See CDC website for most current updates) Complete task training for all routine cleaning and decontamination processes for all surfaces contaminated by a communicable disease to ensure a high level of patient, visitor, employee, and external customer satisfaction. Perform other duties as NECESSARY QUALIFICATIONS Education: High School diploma or GED Experience: Patient Access Specialist I: Must have six (6) months of experience working in a fast-paced office environment Patient Access Specialist II: Must have two (2) years of experience working in a fast-paced office environment with experience with electronic patient registration software, or similar patient financial services Certification: Must maintain a current valid certification of the following throughout employment, if onsite: Basic Life Support (BLS) from the American Heart Association Other Skills and Abilities: A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers. All employment references must address and indicate achievement in each one of the following areas: Must have excellent customer service skills, personal and telephone communication skills Ability to manage multiple priorities and deadlines. Proficient knowledge and ability to use computer software Demonstrate through work history the ability to complete special projects; the ability to meet departmental deadlines, analyze, research, and troubleshoot. Demonstrates the ability to solve problems following chain of command Experience with special projects to meet department demands, must work independently, analyze, research, troubleshoot 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 manage sensitive and confidential information Must be proficient with typing and accurate spelling and grammar Ability to work independently with minimal to no supervision Ability to work under conditions of frequent interruptions and availability to work a flexible schedule Possess and employs an ability to communicate with patients and families during time of emotional and physical Responds positively to supervision to enhance and improve work performance Completion of above-satisfactory scores on all job interviews, demonstrating to the satisfaction of the interviewees and TCRHCC that the applicant can perform the essential functions of the job Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers demonstrating to the satisfaction of TCRHCC a record of satisfactory performance and that the applicant can perform the essential functions of the job Successful completion of fingerprint clearance requirements, physical examinations, and other screenings indicating that the applicant is qualified to be employed by TCRHCC and demonstrating to the satisfaction of TCRHCC that the applicant can perform the essential functions of the job Submission of all required employment-related documents, applications, resumes, references, and other required information free of false, misleading, or incomplete information, as determined by TCRHCC. MENTAL AND PHYSICAL EFFORT The physical and mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be given to individuals with disabilities to perform the essential functions. Physical: Work is mostly sedentary requiring continual ability to sit, stand, walk, twist, and reach for long periods of time. Incumbent will be interviewing patients and preparing the appropriate paperwork for treatment of a patient or initiating a chart. May need to push, pull, and lift up to 10 pounds in the work area. The Incumbent must have the ability for continual near vision, color vision, seeing in fine detail, hearing normal speech, hearing overhead pages over a loudspeaker, telephone use, and occasional ability for far vision. Must have hand manipulation ability simple grasping and use of keyboards. Incumbent will have continual exposure to infectious disease; dust, fumes, gases; and loud noises. Mental: Must be able to effectively communicate to the patient what specific information is needed, the reason for requesting such - information and be able to ascertain that it is accurate as possible. Consequences of obtaining inaccurate information may delay necessary medical treatment, delay billing process, and cause unnecessary frustration and problems. Incumbent must be able to cope with high level of stress; make decisions under high pressure; cope with anger/fear/hospitality of others in a calm way; concentrate; work alone; demonstrate high degree of patience; adapted to shift work; and manage multiple priorities in stressful situations. Incumbent must accept a flexible schedule to meet all business needs