Patient Access Representative

Description

Under general supervision of the Patient Access Supervisor and the Patient Access Assistant Supervisor with indirect supervision by the Revenue Cycle Manager, the Patient Access Representative collects and coordinates the use of key demographic information; utilizes the information to manage alternate resource coordination, Purchased Referred Care requests and eligibility services. Uphold the principles of WIHCC’s Vision, Mission, and Value Statements. Maintains confidentiality of all privileged information at all times.

This list of duties and responsibilities is illustrative only of the tasks performed by this position and is not all-inclusive.

Essential Duties & Responsibilities:

• Maintains regular attendance and punctuality.
• Serves as first point of contact as a representative of WIHCC. 
• Interviews patients to obtain pertinent patient registration information; i.e., demographic and insurance information as well as a signature of authorization to enable Winslow Indian Health Center to bill for health care services provided from all alternate resources, including the non-beneficiary services.
• Determines the eligibility of patients in accordance with Indian Health Services and Navajo Area Contract Health Services/Purchased Referred Care guidelines.
• 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/commercial insurance, will be billed for the services they received at the WIHCC, Inc. facility.
• Utilizing the RPMS Patient Registration Modules, manages, key-enters, updates and verifies all alternate resource data necessary for patient registration and for accurate billing through the use of the RPMS and electronic health record system.
• Maintains communication with HIM Dept., Nursing, Medical Staff, Purchased Referred Care, Patient Benefits Coordinators, and the Revenue Cycle.
• Determines the eligibility of patients seeking health care, who have not previously been treated at the facility, by obtaining the Certificate of Indian Blood or other documentary proof of tribal affiliation.
• Receives and screens incoming calls for the Outpatient Clinics directing them to their proper destinations, handles requests for routine information personally, and refers all non-routine requests to the proper staff person.
• Assists providers with Navajo interpretation for patients upon request.
• Makes appointments for patients referred from clinics for follow-up appointments or new visit appointments, consults or specialist.
• Obtains signatures and assists patients in completing new or updated forms required for Patient Registration such as Workers Comp, Motor Vehicle Accident Form, Medicare Secondary Payer Questionnaire Form, and alternate resources.
• Verifies AHCCCS and Medicare daily.
• Provides appropriate scheduling for their designated clinic and provides detailed information concerning eligibility for and availability of specific clinical services.
• Maintains strict guidelines when scheduling for all medical and specialty clinics. 
• Assist with clerical duties such as scanning, faxing and copying documents, etc.
• Maintains a well-organized and clean environment to work at maximum efficiency and prevent transmission of infection and disease.
• Requires completion of tasks or duties assigned by a supervisor.
• Uphold all principles of confidentiality and patient care to the fullest extent.
• Adheres to all professional and ethical behavior standards of the healthcare industry.
• Adheres to WIHCCs Personnel Policies and Procedures, departmental policies, rules, and regulations.
• Interacts in an honest, trustworthy and dependable manner with patients, employees, visitors, and vendors.
• Possesses cultural awareness and sensitivity.
• Maintains compliance with all Human Resources requirements.
• Performs other duties as assigned.

Qualifications

Minimum Qualifications:

High School Diploma or GED. One to two years clerical or customer service-related experience and/or training. Administrative experience in a health care setting preferred. Basic medical terminology, and Computer proficiency. CPR Certification within three months of hire. Bilingual skills in English and Navajo language highly recommended. Must maintain a valid unrestricted and insurable driver’s license. Must successfully pass a background investigation and maintain suitable requirements for a Child Care position. This position is considered as a Child Care position, which requires a satisfactory background check investigation and is subject to the requirements of the Indian Child Protection and Family Violence Prevention Act, as amended (henceforth referred as the ICPFVP Act).

Knowledge, Skills, Ability:

• Knowledge of the RPMS, EHR, and VISTA Imaging programs, their functions, how to obtain information when needed, and how to correct errors.
• Knowledge of Medicaid, Medicare, Private Insurance and other Third party payers
• Knowledge of the Navajo Area and WIHCC, Inc. Contract Health Service/Purchased Referred Care Delivery Area and regulations and procedures.
• Knowledge of the Privacy Act of 1974, Health Insurance Portability and Accountability Act (HIPAA) of 1996, HITECH Act of 2009 and the WIHCC Policy and Procedures and the use of confidential information and health records as an integral part of the interviewing office function and the privacy of individuals.
• Knowledge of strong work ethics in the workplace.
• Knowledge of basic medical terminology
• Knowledge of application of confidentiality.
• Knowledge of basic computer skills, e.g. Outlook, Word, Excel, PowerPoint, Publisher and Internet.
• Ability to work under the pressure of dealing with multiple tasks and constant deadlines, while maintaining an attention to detail and accuracy.

• Ability to independently make decisions, devise solutions, and take action based on program knowledge related to patient registration.

• Ability to maintain positive working relationships with patients, providers, visitors and staff
• Ability to obtain CPR certification.
• Ability to be dependable in attendance and job performance.
• Ability to meet attendance, overtime (if necessary), and other reliability requirements of the job.
• Ability to accept and learn from feedback.
• Ability to communicate effectively both verbally and in writing.
• Ability to provide exemplary customer service at all times.
• Ability to interact positively with others and possess great interpersonal skills.
• Ability to communicate effectively both verbally and in writing.
• Ability to provide exemplary customer service at all times.
• Ability to be a great team player.
• Ability to accept and learn from supervisor/peer critique.
• Ability to be flexible and adaptable to the changing needs of the organization.

Physical Demands:

While performing the duties of this job, the employee regularly is required to walk; sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee frequently is required to stand; climb or balance; and stoop, kneel, crouch, or crawl. The employee frequently is required to taste or smell. The employee must occasionally lift and/or move up to 25 pounds.   

Work Environment:

Work is performed in an office setting or outdoor work environment with a moderate noise level. Work environment may involve exposure to physical risks, such as blood borne pathogens and operating dangerous equipment or working with chemicals. Extended hours, irregular shifts, location change & rotation, evening and/or weekend work may be required. 

As required by P.L. 93-638, absolute preference will be given to qualified Navajo applicants.  If there is no qualified Navajo applicant, preference will be given to qualified American Indian applicants.