The Resource Center has been providing services to persons with disabilities in the Chautauqua County area since 1958. From our humble beginnings as a gathering of parents and concerned citizens who wanted to provide educational and training opportunities for persons with developmental and intellectual disabilities, The Resource Center has grown into a comprehensive agency providing services to thousands of persons with all types and levels of disabilities.
The Resource Center is the largest non-governmental employer in Chautauqua County with more than 1,300 employees on its payroll.
The mission of The Resource Center is to support individuals with disabilities and other challenges in achieving maximum independence, contributing to their community, experiencing lifelong growth, and enjoying quality of life.
PATIENT ACCESS REPRESENTATIVE/NAVIGATOR JOB DESCRIPTION
CUSTOMER SERVICE/ SCREENING/ NAVIGATION:
1. Provide empathetic and culturally competent screening for social determinates of health to community members telephonically, virtually and/or in-person.
2. Greets and assists individuals, visitors and co-workers across a variety of disciplines and service environments in a prompt, courteous and helpful manner.
3. Process screens and referral intake daily including calls with potential program participants, documentation, and insurance/ eligibility verification.
4. Answers telephone, screens calls, takes messages and provides information on behalf of individuals receiving services within various environments.
5. Optimizes satisfaction, and screening/navigation services when scheduling appointments in person and/or by telephone. Conduct In-Home Assessments or telephonic assessments with community members.
6. Ensures patients comfort by promptly addressing any questions and/or concerns.
7. Protects individual’s rights by maintaining confidentiality of personal and financial information, and complies with State, Federal and Practice guidelines.
8. Investigates and resolves issues with accounts in a timely manner.
9. Aids individuals in distress by promptly and effectively responding to emergencies, by linking to, collaborating with, and/or referring for services.
PATIENT RECORDS:
1. Utilizes a variety of EMR systems and IT platforms systems for the collection, compilation and entry of information to ensure complete, accurate and up-to-date records.
2. Responsible for documentation, medical and insurance referral records, protocols and tracking, including maintenance of records, resolving individual referral issues, and securing prior authorizations for collaboration and treatment, as applicable.
3. Assists in responding to requests for Release of Information, including location and distribution of needed documents, in a timely manner and consistent with HIPAA guidelines.
4. Ensures the timely and accurate entry and/or filing of paperwork and electronic transfers of information received from outside sources into patient record.
PATIENT ACCOUNTS:
1. At the time of each visit, verifies all patient information, including but not limited to demographic and insurance information, patient contact, payer contact, registration interfaces and automated processes.
2. In order to facilitate the receipt of all reimbursement due, works with the Program manager or designee to:
a. investigate and correct errors
b. research missing or incorrect account information
c. identify issues/trends with payers
d. appropriately update account activity
3. Refers patients to appropriate personnel for billing issues, navigation and care coordination as need arises.
ADMINISTRATIVE SUPPORT:
1. Performs clerical duties including typing, filing, and recordkeeping for services provided linked to Social Care Outcomes and program management. Performs medical records maintenance and transcription duties as needed or assigned.
2. Ensures work areas are maintained in a neat and orderly manner.
3. Reports any ideas and suggestions regarding processes, procedures and protocols to management in order to facilitate the smooth and efficient operation of assigned service environment(s).
OTHER:
1. Performs all other duties as needed or assigned.
2. Ability to provide off site services as required by program and schedule.
3. Be able to flex daily scheduled work hours per job task requirements to meet with individuals for job related task completion within standard work week.
Primary responsibilities:
1. Closing the referral loop including but not limited too
a. Ensuing that received referrals are attached to the patient record when they are complete
b. If referrals or screenings are overdue contacting the patient or referring provider and/or referral source to check the status
c. Requesting records from referral source as applicable
d. If patient has not made or been to appointment find out if patient needs additional assistance to keep/make appointment.
2. Assist with GAPS in care reports to achieve quality measures, as applicable
3. Understand HEIDS quality measures and how they are achieved for quality performance
4. Share the services that are offered at The Resource Center
a. Attend community-based events to share program information with individuals, community partners, external agencies/providers to encourage referrals to operating programs.
b. Drop off materials to agencies or other providers to open referral networks and encourage collaborative care.
c. Attend local community meetings focused on Social Navigation and Screenings as directed by supervisor.
6. Complete internal referrals from department to department as applicable
a. Ensuring releases are completed at time of referral and scanned into EMR programs
7. Help guide patients through the Healthcare and Social Network systems
8. Enrolling patients in all services offered by The Resource Center in a timely manner, as applicable and requested
9. Aggregate data collected for patient satisfaction surveys for additional reporting/QI projects
10. Work to overcome obstacles that patients may have the they can receive the care they require
11. Promote client health, health education, and overall system wellness.
RESPONSIBLE TO: Clinical Services Administration Supervisor
FUNCTION:
Welcomes patients in a positive customer-focused manner. Perform a wide variety of activities designed to facilitate and maintain the smooth, efficient flow of operations within a variety of integrated care settings including dental, behavioral health, primary care, health-related services and care coordination. Ensure the timely and accurate collection of all required pieces of information for patient’s demographics, insurance and billing of all services in order to provide accurate information for the providers as well as obtain maximum reimbursement. Maintain confidential healthcare information recorded in the Electronic Health Record (EHR) system in a timely manner in order to provide the most complete and accurate patient record possible and to facilitate optimum patient care.
REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:
Exemplary customer service skills, including the ability to effectively deal with a variety of individuals including patients, providers and other customers in a calm and professional manner; excellent telephone and verbal communication skills, as well as, effective interpersonal skills which promote cooperation and teamwork; Demonstrated ability to effectively utilize multiple Electronic Health Record Systems, including but not limited to Anasazi, AllScripts, Dentrix, and Therap, in addition to computer software programs such as Microsoft Word. Comprehensive knowledge of information gathering, processing and filing systems; working knowledge of medical records management and office administration protocols, as well as, working knowledge of basic accounting and billing principles; flexibility, reliability and ability to self-direct and self-initiate in order to meet deadlines. Must be detail-oriented and possess strong organizational and time management skills, including the ability to effectively manage multiple priorities in a competent manner. Typing ability sufficient to perform data entry. Physical condition or reasonable accommodation(s) commensurate with the demands of the job.
MINIMUM QUALIFICATIONS:
PATIENT ACCESS REPRESENTATIVE Associate’s Degree in business, accounting, medical office or related field plus one (1) year of demonstrated office experience. Experience in medical office or medical billing strongly preferred; OR three (3) years of demonstrated office experience. Experience in medical office, registration, or medical billing strongly preferred. Candidates who are bilingual in English and Spanish preferred.
PATIENT ACCESS NAVIGATOR Associate’s Degree in business, accounting, medical office or related field plus two (2) years of demonstrated office experience, a minimum of one (1) year of which was in a medical office, medical billing or related capacity; OR four (4) years of demonstrated office experience a minimum of one (1) year of which was in a medical office, medical billing, or related capacity. Candidates who are bilingual in English and Spanish preferred
7/30/2020, 3/2025
Multiple Service Environments
The Resource Center
Salary Grade: 12 /13
FLSA Status: Non-Exempt
PTO/CAT 3
CFR: 505
The Resource Center is an equal employment opportunity employer and will not discriminate on the basis of race, color, creed, religion, sex, sexual orientation, gender identity, national origin, age, marital status, citizenship status, military status, domestic violence status, predisposing genetic characteristics or genetic information, physical or mental disability, any other category protected by law, or any other non-job related characteristic. As needed, The Resource Center will provide reasonable accommodations for disabilities to employees and applicants whenever such accommodation would not create an undue hardship or a safety concern in the conduct of TRC’s operations.
