Patient Access Specialist - Part Time with Benefits

Job Title: Patient Access Specialist

Job Code: PTACSPEC 

Department: Patient Access 

Division: Finance

Salary Level: Non-Exempt 4

Reports to: Patient Access Manager/Member Services Manager 

Last Revised: February 2022

Primary Function 

Greets all patients, families, visitors and coworkers in a prompt, polite, and helpful manner 

and directs them, as necessary. Determine, verify, and explain CIHA eligibility to patients, 

check-in or registering patients for their visits, and answering all incoming calls to the 

facility. 

Answers the EBCI Tribal Option Member/Provider Services1800 number and effectively 

direct callers to the appropriate party, provide warm transfers when necessary and 

appropriate and provide external referral information to assist members/providers to get 

their needs met. Responsible for conducting patient interviews, distributing, and obtaining 

signatures for paperwork, entering pertinent information including demographic and 

insurance, verifying insurance eligibility, determining, verifying, and explaining services, 

and collecting co-pays if applicable. Receives complaint/grievance calls in a welcoming 

and supportive manner. Logs complaint/grievance information into the customer service 

platform and elevates complaint/grievance calls as appropriate to Tribal Option 

Management staff. 

Job Duties

Patient Relations Duties

• Interviews patients to obtain pertinent patient registration information, i.e., 

demographic and insurance information and authorization to enable the Business 

Office to bill for health care services provided from all alternate resources, including 

the non-beneficiary service. 

• Verifies all information collected for accuracy. Verifies insurance coverage through the 

health plan and determines applicable co-payment and collects co-payment if 

applicable. 

• Creates and completes new charts in the BPRM Patient Registration System after 

researching and verifying that there is not an existing chart for the patient. This will 

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include inpatient, outpatient, emergencies and after hour patients, dental patients, and 

mental health patients. 

• Obtains and verifies the health records in the BPRM Patient Registration System for 

Medicaid, Medicare, and private/commercial insurance eligibility information for all 

patients seen prior to all clinic visits. 

• Obtains signature for file on all required forms for alternate resource and contract health 

services prior to patients being seen in the clinics for billing purposes and/or contract 

health services eligibility. 

• Makes corrections as necessary to improve the Patient Registration System. Updates 

PRC eligibility with proper documentation. 

• Collects third party recipient health cards, obtains photocopies of the card and explains 

the program to the beneficiaries, i.e., why Medicare, Medicaid and/or Private 

Insurances will be billed for services they receive at the Cherokee Indian Hospital. 

• Interviews patients to obtain information to initiate a new health record and/or 

communicate to Medical Records to reactivate a retire/stored record. Enters all 

information into the BPRM Patient Registration System and prints appropriate forms. 

• Upon direction initiates all admitting forms to complete the admission with current 

patient data, including BPRM Patient Registration System. Initiates patient 

identification bands for admission. 

• Completes Medicare Secondary Payer Questionnaire for Medicare beneficiaries and 

files appropriately. 

• Transcribes all new insurance information into the BPRM system in all the appropriate 

fields. Verifies if patient has NC BCBS, NC Medicaid, or other private insurance. 

• Calls pending verification patients before appointments to remind of documentation to 

bring in i.e., driver’s license, enrollment care, proofs of residency, etc. 

• Obtains patient signature for Service Agreements, Notice of Privacy Practices, etc., 

scans forms signed by patients into VISTA. 

• Documents MVA/WC in BPRM/RPMS by obtaining signatures for appropriate forms, 

giving clinic appropriate documents, obtaining police reports, entering appropriate 

benefit for coverage in order for the Business Office to bill correctly and alerts clinic 

staff. 

• Documents all changes, updates on the notes page with date, and initials. 

• Collects fees and co-pays from non-beneficiaries, prints register and credit card report 

at end of shift, maintains petty cash and turns all receipts and reports into Finance. 

Member/Patient Service Duties

• Answers eligibility questions for new patients or Members and lets the individual know 

what the benefits are based upon eligibility status.

• Answers the Member/Provider 1800 Tribal Option line consistently and provides 

information, warm transfers, and referral information as appropriate and necessary to 

ensure caller’s needs are met. Member/Provider toll free number is to be answered 

during the CIHA Business Day defined as Monday-Friday 8:00-4:30, except for posted 

CIHA holidays.

• Follow approved Service Line scripts to ensure correct, consistent information is 

provided to the Member/Provider.

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• Log every call received into the customer service platform to ensure appropriate 

documentation and resolution of all calls. This is the foundation of data that is required 

to be provided to the state as part of the PCCM Tribal Option Contract. 

• Promptly returns calls to individuals or entities if a request for a call back is made after 

hours, the return phone call shall be made the following CIHA business Day during 

normal hours of operation. Triages the message and notifies applicable business owner 

based upon the type of information requested. 

• Answers telephone switchboard for all CIHA facilities and directs calls to appropriate 

staff member/department. 

• Maintains an updated list of all departments, personnel, and extensions to assure proper 

transfer of calls. 

• Greets visitors when necessary, answers questions, or directs them to the appropriate 

person or department. 

• Maintains the vendor/visitor sign in and provides vendor/visitors with Visitor badge. 

• Keeps a log of after hour call-in referrals and turns into PRC during regular business 

hours. 

• Determines the need for interpreter or translation services and accesses the necessary 

platform(s) to ensure the individual receives communication in the manner necessary 

to provide effective communication with the individual. This includes but not limited 

to calls to/from Members with limited English Proficiency, as well as Members with 

communication impairments, including those with hearing, deaf-blind callers to 

include TTY, captioned phones, and amplified phones. 

Documenting Member/Provider Grievances 

• Document all Provider or Member grievances/complaints received via the service lines 

or in person. 

• Provide complete and appropriate documentation of all complaints/grievances within 

the customer service platform.

• Elevate complaint/grievances to the appropriate Tribal Option Manager per 

policy/protocol. 

Other Duties as Assigned 

• Performs other duties as requested from the Patient Registration Manager, or Member 

Services Manager

Education/Experience/Minimum Qualifications

• High school diploma/GED is required. 

• An Associate’s Degree in Business and/or Accounting, or a related field, or the 

equivalent combination of training, education, and experience is preferred. 

• Previous data entry experience or clerical experience with customer contact of two 

years is required. 

• Three to six months in the job would be necessary to become proficient in most phases 

of the work. 

Job Knowledge

• Ability to establish and maintain effective working relationships with members of the CIHA 

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team, individuals and their families, and a variety of governmental and private resources and 

organizations in the community.

• Ability to express ideas clearly and concisely and to plan and execute work effectively.

• Must be able to read, research, and interpret computer data or customer service platform 

related to patient/member interviews and eligibility searches. Basic knowledge of 

eligibility requirements of the Cherokee Indian Hospital and the EBCI Tribal Option 

including resources in the local community and neighboring counties. 

• Requires the ability to answer and transfer calls using the phone system and utilize 

computer, calculator, and related office equipment. 

• Requires knowledge of various software packages: i.e. Microsoft Excel, Word, 

Outlook, and the Customer Service Platform and ability to enter information or data 

into the applicable software package. Documentation must be in “real time”. 

• Knowledge of interview techniques and experience in applying various policies and 

procedures in the performance of assigned duties. Must be able to maintain specified 

records, files, and logs of the department. 

• Must have excellent communication skills, both written and verbal. 

• Requires the ability to work independently or as a member of a team. Valid NCDL 

required. Knowledge and ability to work within multiple systems simultaneously. 

• Knowledge of complaint/grievance workflows call transfer matrix as well as Tribal 

Option information and how to locate Tribal Option information to assist 

Members/Providers. 

• Knowledge of the population served and about the Cherokee culture preferred. 

Complexity of Duties

This position is responsible for assisting individuals connect to the right service or entity within 

CIHA/EBCI Tribal Option or the ability to refer to applicable entity based upon eligibility 

criteria. As such, the position requires the ability to listen and filter relevant information in 

order to refer accordingly without causing confusion or disruption to the communication event. 

Duties require the application of judgment and problem-solving skills in order to be effective. 

At times may be dealing with individuals who are concerned about access to services, 

dissatisfied, agitated or emotional. 

• The position requires ability to operate multiple software packages, documenting 

information in the appropriate software platform. In addition, the position must possess 

phone skills, including familiarity with complex or multi-line phone systems. 

Responsibility for Accuracy

Typically, this position is the initial point of contact patients checking in for services 

rendered at CIHA and also for calls received via the EBCI Tribal Option Member/Provider 

Service Line. As such, accuracy is of upmost importance to ensure that eligibility data is 

accurate and information shared is accurate. Responsible for accuracy of demographic, 

eligibility and insurance information obtained and entered into BPRM/RPMS. Errors can 

be detected through interview techniques and subsequent interviews with patients or 

Members. Work can be verified or checked by the immediate supervisor, or other hospital 

staff. Incoming or outgoing calls can be monitored to ensure accuracy and adherence to 

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approved scripts. Logged calls and complaints/grievances must be accurate and meet state 

reporting requirements. 

NC Medicaid requires that calls from Members and Providers be answered in a certain 

manner, adhering to approved scripts. In addition, documentation must be gathered in real 

time, addressing all required fields so that reporting may be conducted and submitted in 

accordance to the DHHS Tribal Option Contract. NC Medicaid or other regulatory 

agencies may conduct “mystery shopping”, audits or reviews to ensure compliance to EBCI 

Tribal Option requirements. 

Contact with Others

This position has primary contact with patients/members and providers for the purpose of

conducting interviews, answering the Tribal Option Member/Provider line, accepting and 

documenting grievances/complaints and the patient/member registration process. 

Secondary contacts include, but not limited to staff within CIHA such as medical records

staff, pharmacy staff, billing office staff, and contract health staff and other external entities 

visiting CIHA or calling in. 

All contacts require tact, courtesy, and professional decorum. Utmost sensitivity and 

confidentiality is required when dealing with patients and families. Consistently demonstrates 

superior customer service to patients/members, providers, and customers. Ensures 

excellent customer service is provided to all patients/members, providers, and customers 

by seeking out opportunities to be of service. 

Confidential Data

All health information and data is considered highly confidential and strict adherence to all 

applicable policies is required. The position has access to highly confidential patient/member

medical and personal information. The Privacy Act of 1974 mandates that the incumbent 

shall maintain complete confidentiality of all administrative, medical, and all other 

pertinent information that comes to his/her attention or knowledge. The Act carries both 

civil and criminal penalties for unlawful disclosure of records. Violations of such 

confidentiality shall be cause for adverse action. The individual must always adhere to all 

CIHA/EBCI Tribal Option confidentiality and security policies and procedures.

Mental/Visual/Physical 

The level of concentration varies with tasks, with close attention to detail required while 

entering data and verifying accuracy of information. Duties of this position require the 

employee to be mobile, reach with hands and arms, speak, and hear. Must have visual 

acuity. Position is subject to frequent interruptions, requiring varied responses. Must be 

able to handle multiple projects simultaneously, work independently, and meet deadlines 

and time frames. May occasionally move more than 15 pounds. 

Resourcefulness and Initiative 

Follows well defined procedures with initiative and judgment required maintaining 

accuracy and complete tasks in a timely fashion. 

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Environment 

Majority of work is performed within the hospital environment requiring interaction 

throughout the hospital. Occasional travel is required. Immunizations are required of all 

employees. 

Customer Service

Consistently demonstrates superior customer service skills to patients/customers by 

demonstrating characteristics that align with CIHA’s guiding principles and core values. 

Ensure excellent customer service is provided to all patients/customers by seeking out 

opportunities to be of service.