Job Description

Job Title: Patient Access Navigator

Hours: 32 hours per week; Monday through Thursday from 9:30 AM to 4:30 PM and Friday from 9:00 AM to 3:00 PM (EST)

Location: 100% remote

Requirements: 3 weeks of full-time training is required from 8:00 AM to 4:30 PM

Job Profile Summary

This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In addition, this role focuses on performing the following Patient Access duties: Performs the administrative and financial-clearance duties necessary to facilitate the procurement of clinical services by patients. Collects patient's necessary demographic and financial information from physician offices, acute-care entities, or the patients themselves, schedules services for patients, and handles referrals from primary care doctors to ensure patients are scheduled for recommended appointments/procedures, etc. An organizational related support or service (administrative or clerical) role or a role that focuses on support of daily business activities (e.g., technical, clinical, non-clinical) operating in a “hands on” environment. The majority of time is spent in the delivery of support services or activities, typically under supervision. An entry level role that typically requires little to no prior knowledge or experience, work is routine or follows standard procedures, work is closely supervised, and communicates information that requires little explanation or interpretation.

Job Overview

Under the direction of the Pre-Services Revenue Cycle Leadership, the position supports Revenue Cycle workflows such as but not limited to Front End Patient Support, Scheduling, Pre-Registration, Referrals and Authorization. The position works within Revenue Cycle as well as other service lines throughout Tufts Medicine to create a system of quality health care. Responsible for assuring that standard process discipline is adhered to. Ensures a high-performance work team is developed through training, coaching, mentoring and bi-monthly meetings. Maintaining a high standard of quality care by achieving set internal department KPIs/metrics. Responsible for supporting inbound and outbound call volume, completing pre-registrations, sending/receiving MyTuftsMed portal messages, support Epic appointment and patient workqueues, generate and finalize patient estimates, receiving and transcribing hospital-based orders, obtaining referrals and authorizations, collections of copays, deductible and/or co insurances.

Job Description

Minimum Qualifications:

1. Minimum High School Diploma or Equivalent

Preferred Qualifications:

1. Experience in insurance, managed care, private physician’s office practice or hospital registration setting
2. Revenue Cycle, Patient Access or Pre-Services experience

Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list. Other duties and responsibilities may be assigned.

1. Utilizes effective customer service etiquette and skills in all phases of telephone communications.
2. Obtains accurate demographic, financial and clinical information from patients/guarantors.
3. Understands and demonstrates knowledge of basic medical terminology.
4. Meets or exceeds patient handling, speed to answer, first patient one call resolution, hold time quality metrics within the context of excellent customer satisfaction and minimal error rate.
5. Maintains a basic knowledge of billing, understands eligibility, referrals, pre-authorization, broad scope of benefits, policy number requirements, subscriber vs. guarantor, and order of insurances. 6. Possess a solid understanding regarding specific instructions associated with various appointment types and procedures.
6. Responds to telephone or electronic inquiries from patients, physicians, employees regarding registration, appointments, patient estimates, provider messages and other services.
7. Generates patient estimates and attempt to collect estimated amounts due prior to date of service and create a hospital account note to support your work.
8. Works to resolve all caller inquiries and issues and demonstrates ability to transfer calls by following customer service guidelines.
9. Accurately and promptly schedules, reschedules, and cancels appointments to maximize resource utilization for optimum efficiency.
10. Instructs patients in preparation of visit by providing any preparation, location and other general information in a professional and courteous manner.
11. Utilizes information systems/tools, such as Epic, Vyne/Trace, Microsoft Teams, Amazon Connect/AWS.
12. Consistently provides the highest level of customer service when interfacing with patients, co-workers, referring physicians and all internal departments and external customers.
13. Participates in the achievement of personal and departmental goals and initiatives.
14. Actively contributes to positive morale and teamwork; supports changes and initiatives and demonstrates good communication skills.

Physical Requirements:

1. Frequent sitting, occasional standing & walking. Mental requirements will be intense at times with involvement in many concurrent multi-faceted projects
2. Requires manual dexterity using fine hand manipulation to operate a computer keyboard and related equipment
3. Requires ability to see computer screens, monitoring equipment and reports

Skills & Abilities:

1. Knowledge of Medical Terminology, CPT and ICD-10 codes
2. Significant knowledge of Medicare, Medicaid, and third-party payer billing guidelines, compliance, and regulations
3. Knowledge of Epic Cadence, Vyne/Trace, Microsoft Teams, Amazon Connect/AWS
4. Proven analytical and critical-thinking skills, as well as strong decision-making, required to synthesize complex data sets.
5. Interpret qualitative and quantitative data and trends to implement recommendations, resulting in measurable performance improvement and successful organizational change.
6. Ability to collaborate with those within, as well as outside of Revenue Cycle to understand challenges, and adapt methodologies and approaches to ensure results align with Tufts Medicine’s objectives.
7. Ability to successfully build relationships with all team members.
8. Strong oral, written and interpersonal communication skills.
9. Ability to work in a complex environment with frequent changes.
10. Excellent organizational skills required with attention to detail.

At Tufts Medicine, we want every individual to feel valued for the skills and experience they bring. Our compensation philosophy is designed to offer fair, competitive pay that attracts, retains, and motivates highly talented individuals, while rewarding the important work you do every day.

The base pay ranges reflect the minimum qualifications for the role. Individual offers are determined using a comprehensive approach that considers relevant experience, certifications, education, skills, and internal equity to ensure compensation is fair, consistent, and aligned with our business goals.

Beyond base pay, Tufts Medicine provides a comprehensive Total Rewards package that supports your health, financial security, and career growth—one of the many ways we invest in you so you can thrive both at work and outside of it.

Pay Range:

$20.12 - $25.15

based on full-time equivalent