Team Lead, Patient Access Navigator - Remote

Hours: 40 hours per week; Monday through Friday from 8:30 AM to 5:00 PM (EST)

Location: Remote

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. A specialist level role that requires very advanced knowledge of operational procedures and tools obtained through extensive work experience and may require vocational or technical education. Works under limited supervision for non-routine situations and may be responsible for leading daily operations, and trains, delegates and reviews the work of lower level employees, and problems are typically difficult and non-routine but not complex.

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 and daily floor support. Maintaining a high standard of quality care by achieving set internal department KPIs/metrics. Responsible for supporting inbound and outbound call volume, supporting staff with their questions, completing pre-registrations, sending/receiving portal messages, support appointment and patient work queues, 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. High School Diploma or Equivalent

2. Three (3) years' experience in insurance, managed care, private physician's office practice or hospital registration setting.

Preferred Qualifications:

Revenue Cycle, Patient Access or Pre-Services experience Four (4) years' experience in insurance, managed care, private physician's office practice or hospital registration setting.

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.

7.Responds to telephone or electronic inquiries from patients, physicians, employees regarding registration, appointments, patient estimates, provider messages and other services.

8.Generating patient estimates and attempt to collect estimated amounts due prior to date of service and create a hospital account note to support your work.

9.Works to resolve all caller inquiries and issues and demonstrates ability to transfer calls by following customer service guidelines.

10.Accurately and prompt schedules, reschedules, and cancels appointments to maximize resource utilization for optimum efficiency.

11.Daily support of all end users to ensure accuracy and efficient workflows.

12.Instructs patients in preparation for the visit by providing any preparation, location and other general information in a professional and courteous manner.

13.Utilizes information systems/tools, such as Epic, Vyne/Trace, Microsoft Teams, Amazon Connect/AWS.

14.Consistently provides the highest level of customer service when interfacing with patients, co-workers, referring physicians and all internal departments and external customers.

15.Participates in the achievement of personal and departmental goals and initiatives.

16.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.Strong oral, written and interpersonal communication skills.

2.Ability to work in a complex environment with frequent changes.

3.Excellent organizational skills required with attention to detail.

4.Provenanalytical and critical-thinking skills, as well as strong decision-making, required tosynthesizecomplexdata sets.

5.Interpret qualitative and quantitative data and trends toimplement recommendations, resulting in measurable performance improvement and successful organizational change.

6.Ability to collaborate with those within, as well as outside of Revenue Cycle tounderstand 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.Knowledge of Medical Terminology, CPT and ICD-10 codes

9.Significant knowledge of Medicare, Medicaid, and third-party payer billing guidelines, compliance, and regulations.

10.Knowledge of Epic Cadence, Vyne/Trace, Microsoft Teams, Amazon Connect/AWS

Tufts Medicine is a leading integrated health system bringing together the best of academic and community healthcare to deliver exceptional, connected and accessible care experiences to consumers across Massachusetts. Comprised of Tufts Medical Center, Lowell General Hospital, MelroseWakefield Hospital, Lawrence Memorial Hospital of Medford, Care at Home - an expansive home care network, and large integrated physician network. We are an equal opportunity employer and value diversity and inclusion at Tufts Medicine. Tufts Medicine does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation by emailing us at careers@tuftsmedicine.org.